August 12, 2020

Hospital Caregiving

Written by: Dr. Pamela Tronetti, DOPamela Tronetti

Sponsored by Parrish Healthcare

Mrs. James sat by her husband’s hospital bed as the days turned into weeks. Every day she peppered the staff with questions, pointed out little problems before they became big ones, demanded to know the plan for the next day, and monitored his diet, physical activity and symptoms.

Each time a new team of residents and students came, she gave them a thorough report. She also made sure that everyone knew that her husband was a person first and a set of symptoms second.

She was the watchdog who protected him. She never had to bite or even growl, but she occasionally had to bark. When someone you love is in the hospital, they need someone to be their advocate, spokesperson, and yes, watchdog. Here’s what you need to do.

You will need multiple copies of your loved one’s medical history, surgeries, allergies, and medication list. Give one to every consulting doctor, nurse, or pharmacist who comes in.

Keep a notebook to record who was in and what they said (“Karen the speech therapist says that mom needs a mechanical soft diet.” “Dr. Bo will read the echocardiogram and may do a cardiac catheterization.”)

Parrish HealthcareBring your own dry erase marker for the room’s whiteboard. You can leave your name, phone number, and notes for the staff such as “Mom is hard of hearing.”

“Fine” is not acceptable. If someone tells you that a blood count, pulse rate or oxygen level is “fine,” get the exact number. You need to track and trend numbers and get printouts of all other tests such as x-rays and cardiac reports. A good option is to access the hospital’s patient portal to see the results of all the testing.

What is your loved one eating? Sometimes when people are admitted they are placed on clear liquid diet and it is never advanced to something more substantial. Check the printout that comes with their meal tray to see what diet is listed. Advocate for as liberal a diet as possible.

On the other hand, if you know that they are scheduled for a test and should be NPO (nothing by mouth) make sure that everyone knows that. The last thing you need is to have an important procedure canceled just because someone mistakenly brought breakfast into the room and your loved one ate it.

And one more hint. Avoid the rush hours when ordering meals. Call in your dinner order before 4 p.m., lunch before 11 a.m. and breakfast the night before if possible.

Get your loved one out of bed. Get your loved one out of bed. Get your loved one out of bed! Unless there is an unstable fracture or critical medical illness, they need to be out of bed and walking as much as possible. If it is too difficult for the nursing staff, ask if there is a lift team who can help the patient get up and move around.

Use your eyes and ears. Check out as much of their skin as they will allow. Note any rash, open sores or discolored areas. Point them out to the rounding physicians. Also report if your loved one was coughing, wheezing, vomiting, constipated, complaining of pain, or if they have any other symptom that worries you.

Know the plan for today, the next day, and the rest of the stay. Get a printout of the orders for the day – labs, procedures, and tests. Then ask what will happen based on the findings. Sometimes it is a watch and wait (if someone is recovering from an acute infection or a stroke), but other times there are definite steps to be taken (three days of recovery after joint replacement surgery then rehab) and you need to be part of them.

Discharge planning is facilitated by the Case Management staff. The case manager is the person who can make arrangements for nursing home, rehab center, and home healthcare. You will want to talk to her early in the stay. You also need to make it clear that you need at least 24 hours to plan for any transfer back home or to a facility.

Remember that you don’t need to have the staff like you. You just need them to do their job while you do yours.

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