Clostridium Difficile : more diarrhoea
Bloodied gowns left on trolleys, clinical waste bags dumped in corridors and blood stains are not what you want in a hospital. (Undercover reporter working as cleaner)
The official Healthcare Commission on Maidstone and Kent NHS Hospital trust does not not provide happier reading.
Shambolic mis-management or, to be more precise, lack of management of infection in a Kent NHS Trust. A depressing catalogue of incompetence. Lack of leadership from the top – and by that I mean from Consultant Microbiologists, doctors with specialist training in infection and bacteriology - was the main problem. Add to that government pressure on non-medically qualified managers to increase hospital turnover with inadequate nursing resources and you have a receipe for disaster.
A few words on Clostridium Difficile.
It has been around for years. It is rare. Contrary to what the media would have you believe, it is not caused by poor hygiene. Just as MRSA lives happily up your nose without causing problems, so C.Difficle lives happily in your colon until the bacteriological environment of the colon is changed. And it is usually changed by an inexperienced junior hospital doctor prescribing a long and inappropriate course of broad spectrum antibiotics. Elderly women frequently get urinary tract infections. Mostly, they can be cured by six tablets of trimethoprim, one twice a day for three days. Cheap, cheerful, narrow spectrum and harmless. But give an inappropriate dose of what inexperienced doctors and nurses tend to view as a “stronger” antibiotic and the balance of the gut flora is disturbed and C.Difficle takes over. (A simple guide to C. Difficile here)
Once a patient becomes symptomatically infected with C.Difficile scrupulous barrier nursing is required. They had neither the facilities nor the skills to provide such nursing in Kent.
Patients and their families who contacted us were unhappy about much of the care received. They told us that when patients rang the call bell because they were in pain or needed to go to the toilet, their call often wasn’t answered, or not in time. Particularly distressing, nurses had told patients to “go in the bed”, presumably because this was less time consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of pressure sores. (Healthcare Commission)The chief executive of the Trust, Rose Gibb, has been instructed to fall on her sword and to do so without pay if the Secretary of State has his way. She, and many of her staff, may yet face criminal prosecution for manslaughter. I feel sorry for her. Far too reminiscent of John Byng. I feel sorry for them all. They were cutting corners to meet government targets.
As they are in a hospital near you.
++++++++++
Long time readers will remember the plastic turd under Dr Crippen's desk. It is still there.
46 Comments:
Welcome back.
"In terms of sorted to the standard that I expect we should be achieving, it will take another six to nine months"
Can't they achieve something reasonable with 24 hours of round-the-clock work? What is their problem exactly???
trimethoprim isn't completely harmless, http://www.emedicine.com/med/topic3412.htm
"And it is usually changed by an inexperienced junior hospital doctor prescribing a long and inappropriate course of broad spectrum antibiotics."
mmm, a bit of speculatio here, a little unfair on junior doctors.
in fact in my experience junior doctors are pretty up to date with their prescribing and pretty responsible with their antibiotics.
I think GPs are hardly blamefree in this area, it's not just the easy scapegoat of the junior doctor, how many GPs dish out cephalosporins inappropriately?
I can't speak for the whole of general practice but, for what it is worth, not me or my partners.
But, whatever we may or may not do, Cl. Diff is a hospital phenomenon by and large. Don't see it in the community.
I agree that the word "junior" is unfortunate. We need another word to describe the very senior "juniors" who are close to becoming consultants.
John
PS Yes, OK trimethoprim is not "completely" harmless. What medication is.
Crippo,
I wonder how nurse prescribing fits into this??
the number of nurses who dish out antibiotics like smarties is a growing problem, often due to their lack of training,
dipstick positive patients with catheters are a particular issue I have noticed
also pushy patients should beware of what they ask doctors for!
...nurses had told patients to “go in the bed”, presumably because this was less time consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of pressure sores
Because of targets? Oh please! There are no possible excuses for this. It's direct, personal neglect.
"Contrary to what the media would have you believe, it is not caused by poor hygiene."
Welcome back John.
I am surprised by the statement you made. Obviously CD bacterium is nothing to do with hygiene but the epidemics are. Like other clostridia, the bacterium is very good at surviving as a spore and the wards where people had CD diarrhoea must have been ankle deep in spores at this hospital.
And I don't feel sorry for Rose Gibb. She was happy to draw her income and say nothing about what she must have known was going on. She could have closed wards or stopped admissions but she wanted her bonus for meeting targets. How many hospital CEO blogs have you come across exposing what has been going on in Hospital management?
The real criminal here was Patricia Hewitt. She wanted the books balanced by the end of the 2006/07 year at any cost and it cost these 90 people their lives.
onathan said...
...nurses had told patients to “go in the bed”, presumably because this was less time consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of pressure sores
Because of targets? Oh please! There are no possible excuses for this. It's direct, personal neglect.
+++++
Well, it is targets you know. The hospitals are forced to hot-bed patients through without time to clean and change the beds properly. Look at the commission report in detail.
As regards the nurses who "nurse" (not the fatuous clip board brigade who are too posh to wash and rush round telling doctors to take off their ties) the ones I know are at their wits end. They cannot be in two places at once and,frankly, it may be better for an old lady to wee in the bed, than fall and break her hip trying to get out of it.
John
"am surprised by the statement you made. Obviously CD bacterium is nothing to do with hygiene but the epidemics are. "
Yep, accepted, I was being a bit pedantic on taking a rigid distinction between CAUSE and PROPOGATION. I am sure that antibiotic prescribing is the main CAUSE but propogation?......well, I wouldn't care to use the lavatories on most public wards, would you?
John
Jonathan,
If you look at a nurses shift on a minute by minute basis there will be at least 8 or 10 requests for bedpans per minute as well as 4 or 5 patients who are so sick that they are on multiple drips etc. Nurse walks away from that stuff to do a 3 hour bedpan/toileting round ( that's how long it would take due to the sheer volume of patients) and she gets her ass nailed to the wall by the NMC. Just such a thing happened to a nurse I know who left an obstructed bowel patient to take someone else to the toilet. He crashed, she wasn't there and there were still 10 other people crying for the toilet. He died because an arrest call wasn't put out in time.
I often wish I could make all of the acute stuff go away and while away my time cleaning, feeding, toileting because those are nice easy jobs. But I am never at a point in my 15 hour shift where it is even remotely safe to take time out. Lunch breaks during a 15 hour shifts have gone the way of the dinosaur. Lots of "clinical support" whatever the fuck they are workers hanging out at the nurses station in uniforms nearly identical to ours though. If you think the death rate was high at maidenstone just you wait to see what it is like when the hospitals have the few RN's around cleaning. I would love to clean the wards and get bedpans but they are going to have to bring another RN in to do the rat race job of trying to keep these people alive.
The financial mess from the targets has led to the hospitals having very very few nurses on the wards. This is how they think they will save money but the additional deaths and complications costs more. My ward is 35 beds general surgery, general medical, high dependency as well as 10-15 care of the elderly beds. We get one nurse and one or 2 assistants anymore that it is. Five years ago it was 4 and 3 and all the patients were taken care of. Now I can't even do a drug round without constant interruptions. If mulitple patients start going downhill there is no one else to see to the others.
Often I am alone with 12 feeds,10 confused patients who are fall risks and climbing out of the beds as well as people who are acutely ill....drug rounds, admissions, discharges, 20 calls per hour from relatives of all my patients. Targets have led us to not having a ward clerk anymore.
The situation has really deteriorated over the last 5 years but this has accelerated in the last 8 months.
Are you actually saying that if your chest tubes come out, or if you have chest pain, or your heparin or insulin drip needs titrating that the FIRST thing you want your nurse to do is go around and see to everyone who wants a bedpan? Every minute of my shift I have this stuff going on simultaneously for multiple people with no control over it and if I make the wrong decision about where to be and when I could end up in huge trouble with the law.
Gosh that was long. Oops. I get longwinded when I am angry.
Ferret - so nurses are responsible for c-diff and HAIs, I must admit I didn't know that.
I would be really interested to read the research article[s] you are quoting from identifying unsafe prescribing by the few nurses who are actually authorised to give antibiotics.
Can you remember the name of it, especially the bit which proves that nurses fail to understand that in-dwelling catheters inevitably become colonised ?
Will you all stop tearing chunks out of each other!
We should know better than to swallow the government spin that it is the Nurse/Consultant/Junior doctor/GP/cleaners fault.
If you buy a mini you don't expect to transport a rugby team; thats not the drivers fault or the cars fault.
Money was severely restricted to the Trusts and they cut back on maintenance and front line staff. I can almost date it to October 2005 because I found that Trusts suddenly stopped employing Locum Radiologists then and I had been keeping an eye on this. This occurred simultaneously throughout the UK. This was about the time that Hewitt said she would resign if the books weren't balanced.
The people we are all blaming are the same people who have been enduring the worse stresses and overwork- look at nurse annes comments and the Maidstone Report which mentions nurses holding their heads in their hand through exhaustion.
The blame lies with Nulabour and their attempts to show that all the money they spent on the NHS wasn't wasted.
a and e charge nurse,
nurse prescribing would logically be implicated to a degree, obviously doctors are implicated as well,
you're rather strange fixation on 'evidence' for everything is more than a little nonsensical, to be honest
does one need evidence that someone with far less training than another person will on average not do as robust a job?
does one need evidence from randomised controlled trials than appendicitis is best treated by appendicectomy?
does one need evidence that letting people without proper experience operate is not as safe as having more experienced people operating?
I think you will find that the idiot behind MTAS, Fiona Patterson, has a lot of crap scientific evidence backing up her methods, stuff published in journals of some repute
the old fashioned tried and tested methods are invariably better than new fangled rubbish, however there is only 'evidence' for the new fangled crap, frequently in lame educatationalist or politically driven journals
in summary, there is plenty of evidence for things that are utter shite, while many of the best things have no 'evidence' behind them, this doesn't mean that all tried and tested stuff should be abandoned and that common sense should be jettisoned,
in fact the inappropriate use of 'evidence' is a large problem in many medical areas today, the evidence based fundamentalists ignore common sense to peddle their drivel
despite that there is evidence that nurses struggle to prescribe outside of very small areas, see Pulse who have covered this
I suppose you'd also want evidence that HCAs aren't dangerous prescribers, before allowing HCAs prescribing rights? no?
FFS common sense out the windom
"New" treatment for C. Diff.
Do not read if you are eating.
http://news.scotsman.com/index.cfm?id=1641252007
Garth your post reminds me of something a colleague of mine once said about the NHS.
"It's all about evidence based practice.....er unless there is evidence that we're doing it wrong and on the wrong path..then we sweep it under the carpet and continue on our merry way looking for more evidence."
Rog- sounds like something Actimel should be selling
You must remember that Byng was shot whilst his political friends were in office (contrary to public belief) and that it was the anger of his colleagues and of the general public that doomed him. I think that is probably true of this case as well.
I was ready to defend junior hospital doctors (being one) but I see you have expanded on what you meant Dr C. However it is worth saying that antibiotic prescribing guidelines are strict and have been in place at every hospital I've worked at. Most now have been adjusted to reduce the likelihood of c.diff, often (in my opinion) at the expense of the most efficacious treatment.
Trimethoprim continues to be first line treatment for an uncomplicated UTI, even when it requires hospital admission.
Plus, as hinted at by anonymous up top, GPs accusing hospital doctors of inappropriate antibiotic use leaves me confused as to which idiom to use. Pot, glass house, black stone kettle.
I see no point in trying to blame nurses (as above) or non-consultants (as in the post) as no one group is at fault.
Dr Ray, I routinely have plenty of patients on Actimel, Yakult and live yoghurts. Yakult had a special deal with my old hospital. However stool donors should catch on...there are plenty of people in the NHS who are full of shit.
Perhaps if we doubled the wage for HCAs (which would cost about a tenner) more bedpans would get changed?
As far as i can see the average nhs trust senior management and exec team are responsible for more death and misery amongst the British people than the Taliban
I suggest we send in a few regiments to round up these wankers, put em in a field, and fucking bomb em
If we are going to run the nhs like Mao's rice production then we should go the full hog and use his techniques against the failing managers?
Would be too nice for some of them, we need to make sure they feel a bit of pain too
the diagnosis of this issue is fairly straight forward isn't it?
If the issues here arise at many other similar hospitals, then its systematic and probably the fault of the government.
If this hospital is significantly worse than the rest of its peer group, then its down to the local management and not the government.
Case solved?
You are too right anonymous. The Maidstone situation is only the tip of the iceberg as far as I am concerned. I have seen more people die since these stupid targets and budget problems. Well intentioned hardworking staff are overwhelmed. The elderly are probably suffering the worst.
nhs failures are little to do with targets
the best businesses all use targets, targets can really help run a good operation, however they need good leadersip and management to go with them
Ah. We're all back I see.
A shocking story from Maidstone Hospital. Thanks Nurse Anne for giving us an excellent from-the-coal-face view that shows exactly how this tragedy came to happen.
Sadly, it sounds from Nurse Anne's description that Maidstone may not turn out to be an isolated example.
I agree with those in this thread who say that trying to pin the blame on junior doctors/nurse prescribers/GPs is missing the point that this is due to a failure of a system rather than of any particular profession.
i dont recall ever being in a hospital in kent, ive seen shit and blood caked on the walls of hospitals up and down the land though, so i cannot believe this will be an isolated case
anonymouse,
you cannot generalise about targets as you do,
if targets are stupid and used badly they can be catastrophic, as in the NHS,
if sensible targets with in built common sense, then they can be of use
like everything, when done well, they can be good, when done badly....
Rog said... "New" treatment for C. Diff. Do not read if you are eating.
http://news.scotsman.com/index.cfm?id=1641252007
Oh, it's just feeding faeces to the sick patient. I thought it was going to be about haggis.
So, nurse anne, on a 26-bedder ward (average size) at full capacity, each patient calls for the bedpan 56 times a day/night?
dr ray
The blame lies with Nulabour
there are fewer doctors and nurses than in 1997? they're paid less?
is this 'the system'? aren't any staff at all to blame?
http://observer.guardian.co.uk/uk_news/story/0,,2190758,00.html
So, nurse anne, on a 26-bedder ward (average size) at full capacity, each patient calls for the bedpan 56 times a day/night?
Jayann
You seem to have missed Nurse Anne's numbers. Just to remind you.
My ward is 35 beds general surgery, general medical, high dependency as well as 10-15 care of the elderly beds. We get one nurse and one or 2 assistants anymore that it is. Five years ago it was 4 and 3 and all the patients were taken care of. Now I can't even do a drug round without constant interruptions. If mulitple patients start going downhill there is no one else to see to the others.
Often I am alone with 12 feeds,10 confused patients who are fall risks and climbing out of the beds as well as people who are acutely ill....drug rounds, admissions, discharges, 20 calls per hour from relatives of all my patients. Targets have led us to not having a ward clerk anymore.
Of course there are good and bad nurses out there, but that situation described by Nurse Anne is one where it's simply impossible even for the best nurses to provide good quality care.
Jayann you totally missed my numbers.
Keep in mind that many patients are elderly and confused and are calling out for the toilet even when they are on it, and 10 seconds after they get back to bed. It is very very rare that we get any patients out of that 35 who can take care of their own activities of daily living. Either they are too acutely ill or too old.
Zarathrusta is correct. One nurse to too many patients is impossible. The other day I was doing a drug round for all 35. Before I even got to patient number 3 I took over 11 phone calls and did 7 commodes. It is like that through the whole drug round. And by the time you get to the last 20 patients 2 hours later they are all upset because their meds are late and they need the toilet again and you aren't getting it for them. Late meds can cause problems. That should be my first priority during this time and the good nurse would blow off everything else until the drugs are safely out and patients assesed.
Leaving your drug round for that stuff is a big no no but I take the risk because I don't like making people wait for stuff and the complaining. I'm not the only one occasionaly makes bad decisions due to the pressure. I can admit it though.
This is not good at all. There simply wasn't anyone else. I had one HCA and she was trying to feed a double digit number of people during this time by herself. There was just the 2 of us. Consultants show up for their ward rounds around this time and expect me to stop what I am doing and follow them around for an hour.
Something like 80% of our new grads cannot find jobs!!!
The reduction in nursing staff is behind so many of the problems in the hospitals that we are reading about.
Nurse Anne,
You report working on a 35 bed ward where the demands from patients are enormous: “at least 8 or 10 requests for bedpans per minute” [i.e. 480 - 600 per hour], the working hours are absurd: you work 15 hour shifts [i.e. 75 hours per week], the staffing levels are appalling: yourself plus health care assistant or two for 35 patients, none of whom is capable of taking care of her/his own activities of living, and which is managed incompetently: the nurses' station is occupied by non functioning clinical support workers.
What have you done about all this? Have you used your Trust's grievance procedure? (Several likely possibilities such as staffing levels, excessive hours and incompetent management.). Have you sought the support of a Union? Have you reported your ward manager and Trust nursing director to the NMC for investigation? (Section 8 in particular of the code of conduct looks as if it could be relevant.)
I've seen more than a few consultants persist with IV antibiotics that clearly aren't working for weeks at a time.
I'm pretty inexperienced, so I try to get seniors to check what I do when I have any doubts. It's just that, especially in our chaotic admissions unit, noone wants to know.
Being a bit more organised about following up new patients would go a long way to helping.
Clearly the C.Diff problem is multifactorial
Staffing levels;
availability of isolation rooms; 4hr waits and shortage of beds;
hygiene;
antibiotic history;
immune status of patients; and possibily even heroic measures to keep very poorly people with failing immune systems alive.
Now, of course, we have C.Diff targets so CEOs will focus on those to keep their jobs. But I wonder what will be sacrificed to achieve that? The mandatory Cost Improvement Programmes which are apparently absolutely necessary if we are to reach to promised land of Foundation Trust staus will leave another part of the health service naked and vulnerable. Any guess where that will be?
What have you done about all this?
The union is aware and so is the NMC. Fifteen hour shifts non-stop are supposed to be 14 hours shifts with multiple lunchbreaks.
This gets extended when we are short and nothing gets done, you get admits at the end of the shift etc etc. If I can get out on time I do. Depends on the staffing and what is happening with the patients. But lately most of us are going over an hour or two unpaid. Certain things just can't be walked away from because it is time to clock out. It's not the ward managers fault as they don't allow her to have any staff due to the financial crisis resulting from the targets.
All of the nursing stuff have come together and requested a meeting with the chief executive who has refused. Repeatedly. I am still holding out that this will happen however.
The real question is: Who doesn't know that we are having more and more shifts like this? A lot of it is down to restructering that has gone on.
Multiple colleagues have written to the MP and one wrote to the Blair when he was in office.
I think the public needs to know what is happening and demand change. The stories that I am hearing tell me that this is going on in general wards at more and more trusts. For awhile I thought it was just my trust. Now I know that others are worse.
zarathustra, yes I did miss '35 bed' but that doesn't actually make that much difference, what does is nurse anne's
and are calling out for the toilet even when they are on it, and 10 seconds after they get back to bed
that explains the figures you gave, yes, and that should have occurred to me. I admit that though I've been on a geriatric ward (visiting, but for a long time) I haven't come across that. (There was one patient there who called 'nurse, nurse' all the time, there were I suppose two other 'screamers', as the consultant called them. That ward was anyway not understaffed.)
All of the nursing stuff have come together and requested a meeting with the chief executive who has refused
this is the kind of important information that (of course) does not usually come out. When I object to people blaming 'the system' I certainly don't include people like the nursing staff at your trust, who are actually tryig to do something. (And, as I should have said, I don't have any sympathy for Rose Gibb etc..)
Staffing levels on acute wards have been dropping at a scary rate of late. My own trust has also frozen most posts for both newly qualified and more senior nursing staff. Many wards have had to make do with extra HCAs via the nursing bank. No disrespect to the HCAs but generally the last thing a ward needs is an unqualified member of staff who is even more limited in what he/she is allowed to do because they are "bank" staff. Over the last few months I have booked extra staff nurses from an agency because I felt they were needed and this has led to me being dragged in front of a room full of angry accountants and the like- not something that I would want to do again. However I cannot stand by and watch. I'm pretty sure that I will eventually outstay my welcome, as they say.
I'm not suprised that the CEO has refused to meet with the nursing staff...saddened but not suprised. What exactly can they say/admit? The great NHS experiment continues...unfortunately the golden rules of any experiment, that you need to plan, implement, quantify, critically report and peer review have been side stepped in favour of quangos and jobs for the boys. On a lighter note, a recent episode of Scrubs (the nurses strike).....quote Dr Kelso "nurses will never strike because they care too much about the patients"...nurses try a literal "go slow" instead. Made me chuckle.
The union is aware and so is the NMC.
and they're doing nothing? (they're doing nothing). I happen to know what it's like to be overworked and have a union and professional association that won't do anything, and a Health and Safety Officer who won't either. (That's how I became disabled. I know that's happened to nurses, too.) One thing. If you've only talked to the local union, it might be worth taking this to the national level and the TUC.
A consultant radiologist seems none too impressed with hygiene at Chelsea & Westminster: http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2007/10/15/hburnett115.xml :
"...As a consultant radiologist, I have a great affection for this NHS flagship hospital. I spent much of my time as a medical student there, and it is where my daughter was born in 1997. But any fond memories that I once had have been shattered by my recent experience.
Reassurances are given regularly to the public about improvements in infection control in hospitals. After Troy's operation, he was given a stomach drain to allow his pancreas to settle down, fitted with drips and a catheter to regulate his fluids – and spent the six days recuperating in a filthy ward.
The drip stand wheels were coated in years of grime and there were unpleasant looking stains on the walls. During one of my visits, I watched in dismay as the cleaner gave a cursory mop to the middle of the bay, considering the job done.
Troy's own hygiene and comfort were no better attended. Too ill at first to wash his own face or brush his teeth, he was left to cope on his own; no one offered to help with his toilet. There was to be no bed bath, either.
Not that it would have been much use: Troy was admitted first thing Wednesday morning, but he was still lying in the same bedsheets on Friday night – by which point they had become stained with his blood..."
nurse anne,
I can't wait to experience your situation 1st hand. I work on a 42 bed ortho ward, supposed to be 6 trauma. In the past 3mths we have lost 8 nurses (6 full time posts) we have 2 nurses on mat leave and 2 on long sick. None have been replaced, on a week by week basis we can sometimes get NHSP or more likely agency, although agency one week means nothing the next. According to staff levels we should have 8 beds closed. However everytime the rest of the trust runs out of beds, those closed beds become open, always with the promise of extra staff, always those extra staff are spirited away to other wards in more dire need.
Everytime we fill in incident reports, everytime the matrix gives an immediate attention label. What gets done? Nothing, and then another nurse leaves.
Oh and those targets other than the (6) trauma, empty elective beds are supposed to be reserved for patients coming into the admission ward, who go straight to theatre without the certainty of a bed to recover in because a 'site manager' is telling us that we must open those beds to trauma.
Just wait until they ban the use of agency at your hospital kiddo. Have fun. We open closed beds when we have a bed crisis which is every day. But no they do not bring in extra staff.
Incompatible targets are the problem. The push to get patients into beds to meet the 4 hr /12 hour targets (breaching these is a sackable offence)
A trust in finacnial difficulties run by accountants..so there are minimal establishments on the wards.. if nurses are sick or on leave then it become crisis management. Ward managers not permitted to employ agency staff..bank staff are often nurses employed by the same hospital already in full time work on other wards who are prepared to work over their safe working hours (often phillipino nurses sending money home) executives that ignore the recommended safe distance that beds should be apart in order to cram more in ....I could go on and on..mutiple system failure..trust and government. Nurses fill in incident forms daily which go to a black hole somewhere. Its miserable..crap doesnt even begin to describe it.
Oh..and the final nail in the coffin for the MTW trust ...the hospital is an ancient crumbling wreck with old Nightingale wards ..new PFI hospital with lovely shiiny single rooms may be funded by the government no final agreement yet ..the latest word from the government is that the hospital have got to continue to claw their way out of financial difficulty before the new hospital is approved ...so more cuts methinks ..catch 22 Is no one able to put 2 and 2 together ?
Anonymous wrote: Incompatible targets are the problem. The push to get patients into beds to meet the 4 hr /12 hour targets (breaching these is a sackable offence)
When he resigned James Lee, the chairman of the MTW Trust has been quoted as writing: ...attempts to get rid of a small minority of poor nurses were ineffective because "NHS employment practices make it difficult to take action, even against transparent incompetence" (Guardian).
In the same organisation someone is sackable for failing to meet targets and someone else is not sackable even when they are transparently incompetent. How are these statements compatible?
I had a patient with proven C. difficile after one single dose of Amoxicillin, given before a dental procedure.
A few days after the Amoxicillin was given, he developed diarrhea, abdominal pain, a surgeon considered operating at one point, it looked like an acute abdomen.
Testing came back positive for C. difficile. We had to question carefully for the dental antibiotic, he'd forgotten he took it just a few days previously. People forget dental work is "medical".
Having visited various friends and relatives in Kent and Sussex hospital over the years, I was actually relieved to hear that standards were genuinely low there. I feared that the whole of the NHS was similarly slapdash, grimy and inconsiderate.
My friend went in with massive back pain. He noticed some old medicines lying in dust under the bed, and pointed them out to a nurse. A week later, they were still there.
My local hospital is the Kent and Sussex - or Kent and Snuffit as it's known. The reputation of the place is truly dire. An anaesthetist friend remarked that nurses are refusing to work there due to the conditions.
It's hardly suprising. It was built in the 1930s, and although the 250,000 people within a 10 mile radius are crying out for decent facilities it's a Conservative area, so the new hospital has been cancelled, then the location changed, and has been in limbo for - by a startling co-incidence - 10 years.
Frankly I'd rather take my chances than end up there.
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