Question about hospital protocol from the husband of a member here

Hi Everyone. I am the husband of 'trouble squared' here. She has received a ton of information here and I thought I would now come for some advise.

We were in the hospital earlier this week, as detailed in her post here: http://www.twinstuff.com/forum/index.php?showtopic=55271

When we left the hospital Wednesday night, one of the residents, on instructions from one of the doctors in our OB group, gave my DW (thats dear wife, correct??) a perscription for a blood pressure/contraction controling medicine and were sent home with instructions to come back to the OB for our weekly non stress test on Monday.

This afternoon we received a call from a different doctor in our OB group (there are 4), who said we need to come back into the hospital today for more blood work, and that we should not have been released on Wednesday without instructions for follow up tests. We went back in, and they ran blood tests. The results, and results from tests earlier in the week, and some follow on symptoms, are leading the doctors to beleive that pre eclampsia has started. We were admitted back into the hospital and told that DW would not be released until after the babies arrive.

At about 9 pm this evening, we ask the nurse what was happening with the perscription for the blood pressure medicine. Was it still valid, or since we were in the hospital now, was it not needed? She went and asked the resident about it. He had no idea that she was taking the medicine (apparently they start a new chart with each admission, regardless of the fact that she was released less than 48 hours previously). His instructions were for us to continue to self medicate with that perscription.

I am pretty upset with these instructions to be perfectly honest. They did not consult her previous chart. They did not ask what medicine she was taking, and now, while in the hospital, they are telling her to self medicate!! Is it me, or does this sound like a disaster waiting to happen? I stressed to the nurse that I want it in her chart that she is on that medicine. I mean what happens if something happens, they give a dose of new medicine, and that causes a reaction to the previous medicine? It seems to me that this is a poor practice of medicine.

I do not want to "be that guy" who quesitons every medical decision as I have no medical training at all. I have already been vocal about other, much smaller lack of communication issues with our OB and I think they are sick of me at this point, so now I am thinking before I speak, but I am having thoughts of something going really badly. If they are making what I think are mistakes now, what happens if pre eclampsia sets in bad, and serious complications arise? Will other small mistakes make it worse? Or am I just being an over protective and overbearing father to be?

Thanks in advance for your help.

 

This is one situation in which I would not worry about them thinking you are a pain. You are the advocate for your DW and babies. They definitely need to look into the medication situation. I have never heard of someone self medicating while in the hospital. You are absolutely right to question them and to demand them to perform their job properly. I would ask someone who is not a resident about what to do with the medication and if you don't get anywhere talk with the next higher up person. This is a far too serious thing to play around. It sounds like you are doing an excellent job and your DW is lucky to have you there looking out for you. I always appreciate my DH when he looks out for me and the babies. Go dad!!!

 

It looks like the medicine your wife was first prescribed is Nifedipine (spelling?), a medicine initially approved for lowering blood pressure, that was later found to stop contractions and is now used to stop preterm contractions.

To go back to the whole hospital protocol, I totally agree with you and with the previous post. It is incredible that she has not been asked what medications she was taking, precisely as they started a new chart. I would complain about this "bug" to someone higher in the hierarchy in the hospital.

Finally, she should not "self-medicate" in the hospital (this is total nonsense) to deal with a condition she is admitted in for. You definitely have to talk to somebody more experienced in the hospital and clarify this. This was prescribed when they did not think she had preeclampsia. Now that she was diagnosed with it, her treatment, if any, has to be clearly defined and in the hospital records. Do not rely on that resident.

Do not give up until you feel comfortable with the answers and the way they handle the situation. Good luck in making your voice heard and please keep us updated.

 

Thank you for the suggestions. We were told by a family friend that we could, and should suggest that we not work with residents. We told this to our doctor and the response what that the residents were their eyes and ears when they were not there so we should not request that. Well, that is fine if all they are doing is looking and listening, it is when they use their brain that scares me. We are going to have a long talk with them, and our doctor tomorrow about this.

Thanks, and I apologize for my first post being so long winded.

 

You do have the right to request not working with a resident, yes they save the dr. time, but that is not your worry. Your post was not long winded, sometimes it takes a bit to explain the situation. Good luck tomorrow and send my best to your DW.

 

Oh my. You definitely need to have a talk with the doc.

I was admitted into the hospital for an extended period of time on two occasions. Previous to both stays, I was on medication (Procardia/nefedipine and terbutaline) for contractions. But while in the hospital, the nurses were in charge of dispensing and charting ALL of my medications that the doctor prescribed. That is just plain ridiculous what is going on with your DW.

I wish I had advice on who to talk to. I know at my hospital we had lots of visits from social workers to make sure things were okay. I would make a stink though. That is just wrong. Her doctor needs to have it clearly indicated on her chart WHAT meds she is on and the nurses need to dispense it appropriately. I am flabbergasted!

 

I'd definitely be concerned. I was admitted to the hospital on 5 different occasions, always on some sort of med when I was. And they always knew about it. Plus they would not let me self-medicate, the nurse had to administer it. My hospital was a teaching hospital and I had my history discussed with me so many times I had a speech ready to recite by heart, mainly because the different residents/students came in several times a day, and rotated. They studied my chart, just wanted to talke to me about it too. My peri group knew me inside and out.

I was on that BP med as well, although I did not have high BP, it was for contractions.

Also, the dietician told me to absolutely not drink grapefruit juice while on that med, not sure why, but just an FYI.

 

Holy moly....

Just real quick, as a nurse, having worked in a hospital....I have NEVER had a patient be advised to 'self-medicate' We actually had to have discussions with patients that they can't self-medicate.

Please have a very frank discussion with your doc. Point out the resident, they obviously need to be re-educated on medication interactions, side effects and the fact that people need to be aware of all medications that people are on!

Sorry, I usually try to temper my responses a little, but this made me very angry for you guys.

And again, pp is correct, they may be your docs eyes and ears, but in this situation, I think I'd depend on the nurses (who are there more often than the residents anyway) and your regular docs are only a phone call away at most.

Good luck, I hope everything is smoothing out for you and don't even begin to feel bad about speaking up!

 

I don't think you should worry about being a bother to them...this is your wife and your children.

 

I agree with the other posters that you need to talk to the Dr.

I have had a similar situation. I have a very complicated medical history and my Dr. assures me that all my info is in the hospital database but every time we end up in the L&D ER for a check, they treat me like a blank slate and don't even have it on record that I am having twins. I find that some of the residents are quite good while some are not at all. The last time we were in with contractions, we were not even given any instructions upon discharge. I am going to have a talk with my Dr. about this the next time I see her because I am now starting to worry about the quality of the care I am getting.

Hope your DW's doc is helpful in making her situation better!

 

I wouldn't worry about being a "pain" or "too vocal." This is your wife and babies' health which is extremely important. Having a good line of communication with your doctor is key in this. Besides...who cares what they think of you in the end. What matters is that everyone comes out of this safely.


I am in the healthcare profession as well, and our hospital has a specific policy against self-medicating (can't even take Tylenol without a doctor's orders). It is best that they are in charge of dispensing all the medications while she is there so that they can watch for interactions if they add other medications, monitor dosing etc.

 

Just real quick.

I was in the hospital with false labor when my regular OB wasn't on call, and the other doctor tried to give me some medicines to stop labor (I was past 36 weeks at that point, and my dr. had already said that it was fine for them to come any time). I know some of those medicines have heavy duty side effects, and I didn't want to take it. My DH was my advocate and backed me up on that and other choices. I am so thankful he did.

Be whatever kind of pain in the butt you need to be to get your wife's care coordinated correctly. It can be embarassing to say no, or to demand explanations (I'm not saying be mean about it, be polite, but just say what needs to be said), but I am so thankful my husband did what he did in that and other situations with my pregnancy.

 

no matter how many time you are admitted they should always have your previous chart of paperwork with your current admission papers ... My grannys is so big that they have 3 folders... they must have each admission information so they now what has been done in the past .. what the doctor has done and so on... You arent a bother no one will look out for you and your family as good as you do so your doing the right thing by questioning everything ... but honestly I would be finding another hospital.... you can hire and fire docs and hospitals... its your money your insurance .. good luck

 

You are her advocate--you should be a PITA (pain in the *ss) because that doctor NEEDS a PITA!

 

If you don't feel like your concerns are being resolved by Monday I would contact Patient Relations/Guest Services... most hospitals have what are referred to as "Patient Advocates" or "Patient Liaisons". They serve to act as a go-between for just these types of situations...

Wishing you and your DW well as you wait for your babies!!

 

OHH MY GOD!!

I am new to this forum and have not introduced myself yet but as a RN here is some pretty straightforward advice coming from a Cnadian Nurse who is a "by the book" practician.

The fact that you and DW have been told to self medicate is not necessarily a bad thing, some hospitals permit the practice but with very STRICT protocol. It sounds as though the health care team is not communicating. I would definately ask to speak with the OBGYN - NOT the resident. You need to have your orders clarified and you also have a right to see your chart/file, no matter how many they have started??? They usually require a MD's presence when you review the file for any questions you might have.

The fact that you have multiple files is VERY suspicious...unless you have been treated at different facilities, they are required by law to request your old file, with no excuses if it is for the same pregnancy. It is usually housed in records in the hospital. I would truly like to think that the OBGYN floor is better organized than what you are telling us.

As a RN I have to apologize, as this is completely unacceptable. Be your wife's advocate. It's nice to get along with everyone on the floor but bottom line, your family's health comes before "offending" any of the staff. I do suggest remaining polite. One of the replies to your posts suggests contacting the patient advocate/liason-a very good idea. Every hospital should have one on staff.

If, God forbid something happen to your wife where she cannot speak for herself,and you are not around and some resident/MD orders a medication that is not compatible with her current medication that she has been told to self medicate and there are no clear records that she has even been taking the medication, she may have an adverse reaction that could have been avoided had everything been documented and tracked by all members of the health care team.

I am rambling but so furious that the care you are receiving is substandard.

Heather

 

That is insane.

When I was in the hospital after having the babies they would not even let me take my prenatals and omega 3 until the PERI put that it was ok in my chart!

 

I'm on an insulin pump and was allowed to self medicate and check my own blood sugars the entire 5 days I was in the hospital - in fact they wanted to send the endocrinologist on call up to talk to me and I refused - I have my own doctor..

that being said with pre-e and bp meds I don't think thats a real swift idea!

 

Hi all. SOrry I have not posted a follow up, but I was at the hospital all day with K.

I am not sure where to start exactly. Thank you all for the feedback. It was certainly helpful and we did what most of you were saying.

Our OB doctor that was on call came in and saw us this morning. Overnight, her medications were changed and it was basically a doubling of the bp meds she was on, so that essentially negated the self medication requirement. WHen our doctor was there, we expressed our concerns about the resident on call (it was not just the self medication, it was also that he was telling my wife that she needed to tell him right then and there how she wanted to deliver the babies. We have spoken at length with our OB about positions and pros/cons of c section v. natural, and we are comfortable with the game plan we have with her). Her response to us was that we are a high risk case and that she, and the rest of the drs on her team were watching us closely.

THat was all fine and good for a few hours at least. THey removed her from 24 hour monitoring, and placed her on hourly bp, and twice daily fetal/copntraction monitoring. THat worked until 5 pm. After 5, they pretty much stopped everything with us. The shift changed at 7, and we did not seen another nurse the rest of the evening. We were in L&D at that point. I called the OB and spoke to her. We went 6 hours without as much as a nurse saying hello. Everytime we rang the call button, someone came in but it was not a nurse. We expressed our concerns, they disappeared and nothing happened. We told the OB dr. this and the result was us being moved from L&D to post natal (or whatever that is called-- we call it the hotel, it is a new section of the hospital that is pimped out). They have more nurses there to watch closer.

We will see how tomorrow goes. I am not happy with the hospital. I know that as was stated earlier that we can fire our hospital, but honestly, we do not have another option. THe other hospital in town is not affiliated with both our insurances, and our OB does not have privlidges there. The next nearest hospital is 45 minutes away. I am confident that we will get this straitened out one way or another, even if that means I have to go and stand on the desk of the hospital administrator to get his attention.

The really ironic thing is that my DW is an attorney. We thought that that fact would possibly get us slightly better treatment out of fear alone. It does not seem to be the case (If it is, I feel sorry for everyone else). We have not dropped that around much, but it is on her charts......

Oh well, off to bed. I am sorry if I rambled some. IT has been a long day and I am a bit punchy right now. My DW was finally sleeping when I left, so that is all I really care about at this point.

 

So another update for this. I have to say, this medical stuff sure is confusing. Our OB came in this morning and told us that everything is begining to stabilize and if it keeps up, DW may actually come home. I hear that with mixed feelings because as much as she wants to come home, we are so scared now that any little ache, pain or headache is providing stress. The hospital adds a sense of security at this point in that there is someone very close in case something happens. At home, while it is comfortable only like home can be, there is always the hyper sensitivity and worry about going back in and the question as to when something simple can turn bad.

So at least for the next few days it will stay the same. We will have to see what they are doing. THe good news in all of this is that we are comfortable again with our medical care and attention, and our questions and concerns have all been addressed. And, most importantly, DW is getting some sleep.

 

I'd be very concerned too. I'm not sure I would target the residents as the culprit but the hospital procedures ect.

Iwould talk to your doc as well as the doc in charge of the unit she is in. This is a dangerous situation. You are her advocate. I agree with pp's. Don't be afraid to be the sqeaky wheel.

good for you!!!!

 

I'm glad you got it all straightened out and that DW is feeling more comfortable. Hopefully they will make a choice that you all are comfortable with as far as releasing her. Good luck and keep us updated.

 

I think you've gotten lots of great advice and how to speak up. One thing that really worked well for my DH during this 2nd pregnancy was to realize that I may be quiet and he needed to be our eyes, ears, and voice. One of the other couples in our birthing class gave us a toy gorilla to take to the birth as a reminder that Paul was the one that was supposed to be protecting us while I gave engrossed in the job of having the baby, just like a silverback does. It's kind of cheesy but remembering the gorilla analogy makes it a whole lot easier to handle doctors.

 

Thanks once again to everyone who has voiced their support. I deeply appreciate it! Thank you all.

The other thing we are noticing is that the nurses play a huge role in speaking to the doctors as well. We knew this going in as my mother is a retired RN, but the girls we are working with are great. The good ones (and you can tell them apart from the nurses who are still learning) ask us questions. When we cannot answer, they help. THey help us understand things better, and, as we get to know them, they are offering suggestions with how to work with the doctors.

And it is kind of interesting how we can work together with the nurses as well, especially with us being realitively new to the service. This evening, for a monitoring, the babies were being especially naughty and the nurse could not get them to stay on the monitor-- they just kept moving and kicking (which in and of itself is an interesting thing to watch). After a few minutes, I asked and they let me do it. I have been watching this so much that I know I can do it, and I know where others have been successful in placing the monitors to get good readings, so she let me, and I was able to get Austin (baby B ) on to stay while the nurse worked the other side. I think Austin heard my voice or something (maybe it was the start of the father/son bonding-- at least that is how we joked about it with the nurse), but in less than 30 seconds he was on, and stayed on for an hour. The nurse was great, and informed us that she would be telling the others that the kids are stubborn, but do listen to their parents at least so I think I may be helping more with the monitoring in the days to come.

THe other highlight of the day was that they let us tour the NICU. We still hold out hope that we will not need it, but it was reassuring to see the level of care that the other children are getting, and to get an idea what they will be up against if they do decide to come early. There were some children that are smaller than ours at this point, and they were doing well. We were impressed with the NICU staff and how they took time to speak to us, and, in the kindest way, they all told us that they were praying that they never saw us again. So, as much as I have complained about the staff at our hospital, we got to see some other areas that we are impressed with and that will certainly make us sleep a little better for the next few days.

So today was a good day. Good luck to everyone as they travel this amazing road of birth and discovery. It is something to see, and as a father who to this point is just pushing my DW's wheel chair and getting her ice, I have the utmost respect for all mothers, and especially my DW.

Good luck everyone!

 

I am glad that today was a better day. The nurses were amazing while I was on hospital bedrest and they helped DH and I through a very difficult time in our lives.

Sounds like your DW is lucky to have you!!!

 

Wow, I am glad that things got straitened out. Keep us updated!

 

What a rollercoaster ride...for both of you. You've gotten excellent advice from the other posts, I just wanted to commend you for going to bat for your wife and babies! We had a complication with a hosptial I did not deliver at, and DH had to become "that guy," which was totally out of character for him. I'm glad he did because our babies health and my health were at stake. Had he not, all three of us would have been exposed to some horrifying X-rays.

Hang in there...you are doing a wonderful job! Give your DW extra hugs from us!

 

I am so glad things are working out so well for you and your DW. She is very lucky to have you standing by her side. Great job dad! I hope all keeps going well and look forward to hearing more good things! Let your DW know that we are all hoping and praying for the best for your family.

 

Really glad to hear that things are going better for you and you DW!