Recognising Risk and Improving Patient Safety - Mildred's Story
Summary
TLDRThe script revolves around Mildred Hill, a 70-year-old woman who experiences a stroke and is admitted to the hospital. George, her accommodation warden, notices her distress and calls for medical assistance. Dr. Small examines her and suspects another stroke, leading to Mildred's hospitalization. The narrative follows her through various medical assessments, including a fractured hip surgery, and highlights the challenges faced by the medical staff in managing her care, including her specific dietary needs due to a wheat allergy. The script also touches on the communication difficulties between hospital staff and Mildred's concerned daughter.
Takeaways
- π· Mildred, a 70-year-old resident at Magnolia Court, experiences symptoms suggesting another stroke, prompting an emergency call to the doctor.
- π₯ Dr. Alex Small is contacted for an immediate visit due to Mildred's non-responsiveness and lack of movement on her right side.
- πΌ George, the warden at Magnolia Court, assists by calling for medical help and later prepares Mildred for hospitalization by gathering her medicines and personal items.
- π Mildred is transported to the hospital with a suspected stroke, and her medical history, including a previous mild stroke and a severe allergy to wheat, is communicated to the hospital staff.
- π₯ At the hospital, Mildred undergoes a series of tests and is admitted under the care of Dr. Small, who notes her right-sided hemiparesis and expressive dysphasia.
- π Communication between healthcare providers is crucial, as seen when Dr. Small informs the hospital staff about Mildred's condition and her need for a gluten-free diet due to her wheat allergy.
- π€ The importance of a coordinated care approach is highlighted as different healthcare professionals, including nurses, doctors, and wardens, work together to manage Mildred's condition.
- π The script illustrates the challenges in communication between healthcare providers and family members, as Mildred's daughter seeks information about her mother's condition and care.
- π A fall results in Mildred suffering a fractured hip, which requires immediate surgery, demonstrating the need for prompt medical intervention and care in elderly care.
- π©Ί The hospital staff must navigate procedural challenges, such as ensuring all necessary pre-surgery preparations are completed, including marking the correct side for surgery and managing post-operative care.
- π The script underscores the complexity of medication management in elderly care, with attention to allergies and the administration of appropriate medications post-surgery.
Q & A
What is the initial concern George expresses about Mildred?
-George is concerned that Mildred may have had another stroke because she activated her panic button, is not responding, and shows no movement on her right-hand side.
What action does George take after suspecting Mildred has had a stroke?
-George contacts Dr. Alex Small to inform him about Mildred's condition and requests that he come to see her.
What is Mildred's medical history according to the script?
-Mildred had a mild stroke about two years ago, mild angina, and a little bit of asthma. She also had an anaphylactic reaction to some pills containing wheat.
What steps does Dr. Small take when he arrives to examine Mildred?
-Dr. Small checks Mildred's responsiveness by asking her to close her eyes, show her teeth, lift her arms, squeeze his fingers, and identify an object.
Why does Dr. Small decide Mildred needs to go to the hospital?
-Dr. Small decides Mildred needs to go to the hospital because she has a right-sided hemiparesis with facial palsy, expressive dysphasia, and lives alone.
What items does George gather for Mildred before she goes to the hospital?
-George gathers Mildred's medicines, a Medi-alert bracelet, and an adrenaline pen, and puts them in her bag along with some clothes and toiletries.
What complication does Mildred experience while in the hospital?
-Mildred experiences a fall, which results in a fractured leg, requiring surgery.
What is the confusion regarding Mildred's condition when her daughter, Jean, calls the hospital?
-The confusion arises because the nurse on the phone is not fully informed about Mildred's condition and is unable to provide specific details about her care or consultant.
What special dietary needs does Mildred have, and why?
-Mildred has a wheat allergy and requires a wheat-free diet due to a previous life-threatening anaphylactic reaction.
What preparations are needed for Mildred's surgery, and who is responsible for them?
-Preparations for Mildred's surgery include marking the affected side, ensuring she is fasting, dressed in a theater gown, catheterized, and has a consent form signed. The nursing staff and anesthetist are responsible for these preparations.
Outlines
π Emergency Stroke Response
The paragraph details an emergency situation where a carer, George, discovers Mildred, a resident at Magnolia Court, has potentially suffered another stroke. George assesses Mildred's condition, noting her unresponsiveness and lack of movement on her right side. He contacts Dr. Alex Small, who advises an immediate medical evaluation. Dr. Small arrives and conducts a physical examination, confirming a stroke and deciding Mildred needs hospitalization. George prepares Mildred for hospital admission, gathering her medications, a medical alert bracelet, and personal items. The paragraph concludes with Dr. Small contacting the hospital to arrange Mildred's admission, emphasizing her medical history and allergies.
π₯ Hospital Admission and Initial Assessment
This paragraph follows Mildred's arrival at the hospital, where she is admitted under the care of Dr. Small, who provides her medical history and current symptoms to the hospital staff. Mildred is noted to have a wheat allergy, a history of angina and asthma, and previous anaphylactic reactions. The staff prepares Mildred for further evaluation, including arranging for a care of the elderly review and ensuring her medications and medical alert bracelet are on hand. The narrative also includes a personal touch as Mildred expresses her daily routines and preferences, offering a glimpse into her life outside of her current medical crisis.
π Family Communication and Misunderstandings
The focus of this paragraph is on the communication between the hospital staff and Mildred's daughter, Jean. A staff nurse, Ken, attempts to update Jean on her mother's condition, using the term 'CVA' (cerebrovascular accident) instead of 'stroke,' which leads to confusion. Jean expresses frustration with the lack of detailed information and the hospital's procedures, particularly concerning her mother's wheat allergy and the need for a wheat-free diet. The paragraph highlights the challenges in patient advocacy and the importance of clear communication between healthcare providers and family members.
π©Ί Preparing for Surgery and Post-Operative Care
Mildred experiences a fall resulting in a fractured leg, prompting the need for surgery. The hospital staff scrambles to prepare her for the operation, dealing with last-minute changes and ensuring all necessary precautions, including marking the correct side for surgery and arranging for pre-operative procedures like blood grouping and ECG. The paragraph also touches on the challenges faced by healthcare workers in managing patient care efficiently amidst a busy hospital environment, culminating in Mildred's surgery and the post-operative arrangements.
β οΈ Post-Surgical Complications and Miscommunications
The final paragraph describes the chaotic aftermath of Mildred's surgery, with the staff grappling with post-operative care and managing her pain. There's a notable lack of preparation and miscommunication regarding Mildred's condition and needs, including her diet restrictions due to her wheat allergy. The narrative captures the tension and urgency in the hospital setting, with staff members trying to address Mildred's needs while also dealing with their own limitations and the pressures of their work environment.
Mindmap
Keywords
π‘Stroke
π‘Panic Button
π‘Hemiparesis
π‘Expressive Dysphasia
π‘Medi Alert Bracelet
π‘Anaphylactic Reaction
π‘Celiac Disease
π‘Epic Pen
π‘Ward
π‘Theater (Operating Room)
π‘Orthopedic
Highlights
Emergency response to a potential stroke patient, Mildred, with immediate medical assessment.
Use of a panic button to alert medical staff in a residential facility.
Initial medical assessment includes checking airways, breathing, and pulse.
Recognition of possible stroke symptoms including lack of movement on one side of the body.
Communication with on-call doctor to report patient's condition and request medical assistance.
Preparation for doctor's visit by gathering patient's medical history and current medications.
Doctor's on-site examination confirms suspicion of a stroke and decides on hospital admission.
Discussion of patient's previous medical history, including a mild stroke and allergic reactions.
Arrangement for hospital admission and coordination with care for the elderly registrar.
Collection of patient's personal belongings and medication for hospital stay.
Emergency contact with next of kin to inform about the patient's condition and hospitalization.
Hospital admission process including triage and initial nursing assessment.
Identification and management of patient's dietary restrictions due to wheat allergy.
Challenges in communication between hospital staff and patient's daughter regarding medical details.
Preparation for surgical intervention following a fall and fracture.
Coordination of pre-operative procedures including marking for surgery, fasting, and medication.
Intraoperative management of patient's condition, including blood transfusion and surgical team communication.
Post-operative care including pain management and monitoring for complications.
Handling of a critical situation where patient's condition deteriorates post-surgery.
Transcripts
mild are you in
there mild are you all
right can you hear me
MD M I'm going to have come in is that
okay no Dre are you all
right let's move that hand for you let's
sit you up dear are you all right can
you hear
me let me just take your puse I think
you may have had another
stroke I think we better get the doctor
here don't worry I'll sh be a second
I'll just use your phone
oh hello this is George wisman warn at
Magnolia Court I think one of our
residents may have had a stroke could
you put me through to the duty doctor
please yes thank
you don't worry Mildred you'll be all
right hi George it's Alex small here how
can I help you hello Dr small I'm with
mild Hill at the moment you may remember
mild she's a lady who had a bad reaction
to we to a while ago oh yes I remember
what's the problem well she's just
activated her panic button and I've come
to see her she's not talking to me and
there's no movement on her right hand
side I've checked her Airways and she's
breathing okay and she's got quite a
good pulse I think she may have had a
stroke again do you think you could
possibly come out and see her oh yes of
course I can um my surgery is going to
finish in about half an hour so I could
be with you in 40 minutes um can you
stay with till then fine that's no
problem okay look George if anything
happens give me a call back straight
away okay thanks thank you
goodbye hello Dr small thanks for coming
so quickly through here please not a
problem
George hello there mild let's have a
look at
you now can you close your eyes squeeze
them tight shut for
me that's good that's good now show me
your
teeth that's that's good now can you
lift your arms up lift your arms up as
high as you can for me that's lovely
that's lovely now then squeeze my
fingers can you squeeze them as tight as
you
can that's smashing that's smashing well
done now keep can you tell me what that
is okay do you know what it
is that's that's good now mrid it looks
as if you've had another stroke now
let's hope that it gets better just as
quick as the last one did but you can't
look after yourself here so I'm going to
call a hospital now
okay George not should have some
medicines um and also a Medi alert
bracelet which he doesn't seem to be
wearing at the moment um and there
should be an adrenaline pen somewhere
she doesn't like wearing the bracelet
but I found most of the medicines and
put them in her bag along with the
bracelet before you got here but I
didn't see anything about a pen I'll go
and take another look okay oh hello um
could you please put me through to the
registar on call for care for the
elderly thank
you hello you beat
me
okay hello
hello this is Dr small of meadow Bank
Health Center is that the care for the
elderly registar on call uh no it's the
sh oh all right I've got a lady here
that I'd like you to see and possibly
admit M her name is Mildred Hill she's
age 70 mhm she lives in a warden
controlled
accommodation she had a mild stroke
about 2 years ago but made a complete
recovery within a couple of days she
normally looks after herself she's got
mild angina and a little bit of asthma
and she normally takes salbon and gtn
when she needs it I've just been called
to see her and she's got a right sided
hemiparesis with facial py now she does
seem to have some expressive dysphasia
but I'm certain that she understands
what I'm saying to her now she needs to
come into hospital because she lives on
her own um a few years ago she did have
an anaphylactic reaction to some pills
that we prescribed for her that turned
out to have some wheat in them so you'll
need to be careful what you prescribed
for her she has an EP which as far as
I'm aware she's never had to use but she
does have to follow a Celiac diet okay
send her in and I'll see her in
[Applause]
Annie I found her dreading pen I put it
in a wash bag along with some toiletries
oh when I put some clothes in here for
you Mildred I hope they're all right did
you want me to Fone the ambulance while
you do that that'll be very kind of you
George do you know the number yes no
problem oh one more thing George um do
you know who the next kin will be yes
it's her daughter Jean Hill she's head
mistress lives in
Bristol I'm going to telephone Gan for
you Mildred and let her know what's
happened and tell you're going into
Hospital you'll be all right then now M
I've come to see in the hospital take
care okay you nice truck we're going up
a ramp M and a bit of a bump coming up
here I'll tell you what the last we have
on this un not with this
driving right then mild Bill's going to
nip off get your check in all right
you're comfortable we won't be too
long I'm sure they went belong M all
right hi jet hi hi this is uh Mrs Hill
she's a 70y old lady who we've admitted
by the GP with a suspected
stroke jenet there's four patients about
to breach four hours can you get hold of
Sue yeah she's in charge Sue's at a bid
management meeting what about Tracy
Tracy's off sick today okay give me 10
minutes yeah come and sort it myself
thanks that's a GP letter from Dr
small um she's got quite a few tablets
she in Hala gtn and a few other bits and
Bobs that I've just bagged up and I'll
leave them for you um our robs have been
really stable in the Jan can't find the
spare for the stret for Mr James here I
this one for now
as I say her OBS have been really stable
in the ambulance so we've been really
happy with her there um just one last
thing she has got a wheat allergy and
she's got a Medi Alert bracelet and an
epic pen I've left those in a toilet bag
okay so no lead for that Janet the
battery where's Mr
Brown so I've left those in there for
you jet okay and I think that's really
everything I need to tell you is that
okay all right then mild the hospital
will take care of you now all right I'm
going to go catch up with Bill have a
cup of tea take care of yourself
see
you Janet you're supposed to be on your
break let see the back of this one I
just started enough
today okay this is Mildred she's been in
for 3 hours so really we need to get a
mov and if she's not going to breach
okay we need a care of the elderly
review um I haven't seen Dr banson all
afternoon like there's one set of OBS
done but really she could do with
without another set on you um I've
started a notes and I've packed way
belongings as well okay oh and while I
think about it gp's letter all right
she's had a stroke so OB see the sooner
we get her admitted the better that's
fine J all right I'll take over from me
you're going to have an nice
thank right M duck we better get your
sorted out and we get you into a nice
Hospital gwn shall we oh dear you seem
your wet yourself don't worry don't get
all upset I'll get somebody to come and
out we change your bed
Amy can I have some clean sheets please
this ladies w
[Music]
s Hello darling Oh it is rotten weather
out there the Damned wind it's kept me
awake all night I'm going to get
absolutely soak going to the bingo
tonight tea coffee tea it is them and
nice toot of whiskey and this would be
lovely wouldn't it I also have a drop of
Brandy in M before I go to bed at night
my billy gets on to me something WR but
it's never done me any arm there you go
sweetheart oh have you seen what these
kids have done to this bush shter out
front it's absolutely disgraceful and
the language they ought to be ashamed of
themselves Hello darling Oh it's rotten
weather out there the winds kep me awake
all night get me washing I'm okay let's
get you sorted out shall
we
forward there you go oh it was a busy
shift
want it
just for ages them yeah so is this the
stroke lady yes is she about finished
well we just got to get a gown on her
sorry I can't tell you much about her
actually because Janet's on a break I'm
just covering for her she got a little
bit agitated a little bit earlier on but
we SED her out now we bled her up well
don't worry I've got all the information
I need from the GP thank you very much
this lady's going to be here quite a
while cuz I've got another seven
patients to see
hello Mrs Hill your daughter sent you
these flowers lovely I'll just put them
there I'll put them in a bars later I'll
just go fill up your water
okay all right Mrs Jones I'll go and get
you those
tablets don't worry about filling out
those forms I'll help you with it when I
finish this oh hi is that
Jean yes this is M Hill to whom am I
speaking hello Miss Hill this is Ken
staff nurse on Ward 12 where we're
looking after your mom just so i' give
you a quick call to let you know where
she is and what the visiting times are
I've just spoken to George wisman my
mother's accommodation Warden he didn't
say much can you tell me about my
mother's condition well she's had a CVA
but she's nice and comfy now and she'll
be back up on her feet real soon what's
the CVA cble vascular accident Mr wisman
seems to think she's had a stroke well
it says in her notes here that she's had
a CVA is that the same thing it's very
similar look who's her consultant and
when can I speak to
him um I'm not really sure who a
consultant is we've got lots on the ward
you see well she must have a consultant
looking after her who is it um it's like
I'm trying to tell you we've got lots of
Consultants um but I'm sure that by the
time he comes down and visitor will be
able to tell you who it is well that's
not acceptable what investigations is
she having have Arrangements been made
for her scan she had a scan last time
well we won't know that until than the
ward round and whose Ward round is that
then the
doctors and which doctor might that be
Mildred's doctor is there anybody there
I can speak to who actually knows what's
happening to my
mother well sister's on a
break look we're getting nowhere here
young man has she told you about her
wheat allergy well she can't talk what
do you mean she can't talk just like I
told you she's had a CVA what else is
the matter with her she can't talk what
else can't she do um I'm afraid I can't
give you that information over the
phone excuse me but you can't give me
information about my own mother you just
told me that she's desperately ill and
now you're telling me you can't give me
information about her I'm sorry it's
Hospital
policy well the hospital policy isn't
helping as much here is it well there's
nothing I can do about that I'm
sorry well I have some information for
you my mother Mrs Hill has a severe
allergy to wheat she's already had one
life-threatening reaction she carries a
Medi alert and has emergency medication
now you must make sure all this is
documented in her
notes um well we've got all our drugs
and I've got a dietician with me right
at the a minute we know all about a
Celiac
disease no no it's not celiac disease
it's an allergy to wheat I know all
about celiac disease I have children at
my school who have it and that is not
what my mother has she does however
require a wheat free diet right
um look I'm really not very happy can
you at least get her consultant to call
me I can't get away from here at the
moment I'm on my own with the horses
okay I'll pass the message on to Sister
bye God she was hard work listen I need
a dietician input I've got a lady over
there with sea disease and her
daughter's just told me that she's got a
wheat allergy can you sort it yeah sure
just just just give her a pink menu
cards oh okay no problem
then just hold on to our hands that's it
keep your feet a little bit further
apart if you can that's it I'm going to
take some steps towards the
chair okay that's it lots of Little
Steps over towards
me good bit further that's lovely right
can you feel the chair behind your legs
yeah you want to reach down with your
hands for the chair arms then and just
low yourself down nice and slowly good
well done that's really good you should
be up and walking with a stick in a
couple of days
oh dear dear
H stay still Hanah Hanah just sit with
Mrs Hill while I get some help you just
had a fall we just get some help okay
you just stay still Mrs Hill just stay
down there and we'll get you checked out
okay
so as you can see this is a female
pelvis the legs there and at least it's
a nice clean break theater yeah can I
speak to the theater coordinator please
speaking um I've been asked to book in a
fractured NEC aema by the orthopedic sh
can we get on the trauma list not
today's but there is a slot I can fit in
tomorrow would that be okay yeah
whatever that's fine can you give me
some details mild Hill Hospital number
don't know date of birth don't know that
either oh well could you get those for
me dear I don't have the notes well
could you give me a ring back with them
then dear yes all right which consultant
is she under Dr Ross no the orthopedic
consultant Deary you'll have to ask the
orthopedic Sho he's the one that saw her
all right I'll speak to Kevin at
lunchtime now you're going to have to
get her ready for theater do you know
what you're doing yes which side's
broken um it's the right I think but
she'd be coming down to theater with her
x-ray anyway can you mark it then what
the X-ray no the side dear what with a
marip pen surely that's the orthop pod's
job well yes but he's stuck in theater
and it would certainly speed things up
if you could do that for me dear yes all
right and can you make sure she starve
from midnight and pop her into a theater
gown first thing make sure she's ready
it could be anytime during the day and
she'll need to be on a canvas right
right she'll need her jewelry taped and
a theater bracelet and all it's Mr
Heisenberg tomorrow and he likes some
dextran and antibiotics and get her
catheterized before theater right you
are uh now then dear we've had a bit of
trouble with consent forms not being
done from some of the wards we had to
cancel one yesterday and you wouldn't
like that to happen to your patient
would you dear so can you make sure
that's filled in properly and can you
get an anesthetic review before tomorrow
she doesn't need a review She's Fit for
surgery rose rose oh oh One Last Thing
Before I Forget can you group and save
her and get her an ECG and chest x-ray
for the anst that'll be lovely rose
where the hell are you woman mustache Mr
Eisenberg wants me
Cheerio right Ken I'll need a marker pen
that I consent form I'm going to have to
get her ready for theater tomorrow there
you
go thanks very
much before forget Bert and Elma want to
be remembered to you it's not too warm
for you in here is it right Mrs
Hill they're going to be fixing your
broken leg tomorrow so I need you to
sign this consent form okay she won't be
able to sign that she's right-handed
well that's okay Mr Hill you can sign it
I'm not Mr Hill actually I'm the warden
well that's fine you're her carer you
could just sign here please
what's this R does it stand for right
yes but it's a left leg isn't
it give me the form I'll change
it there will you sign it
now one last thing Mrs Hill I need to
mark up your leg for surgery
damn crash call we'll have to do this
later Rose where's this bloody neck of
FEA Cas to do down the road and I've got
to get on she's just on the way now Mr
don't worry I'll ring thefield and tell
be a few minutes late sorry
on my list we finished sorry it's on the
revised list well that's not going to
get done is it there's no way she's
going to be out recovery by five that's
going to be down to your anesthetic deer
isn't it I'm going to be done in dusting
in 10 minutes I'll be finished I'm off
five and there's no recovery there's no
to oh for Christ sake listen to you lot
come on let's going to crack on it's
going to be 15 minutes we'll be done
here hello my dear I'm the surgeon I'm
going to fix this leg of yours all right
you mind if I have a quick look
you the student nurse that's brought the
patient down from the Ward we do this
operation every day five days a week
this patient she's come down she's not
marked there's no drip she's not
catheterized and she's not even had the
bloody antibiotics Gro will you get this
sorted out please I'm going to go and
scrub up come on let's crack on and get
out of here come on one of these in no
chest remember last what are you moaning
about Mr H stopping and getting to the
pub early again I'm going to be here
until six my patient's not even arrived
yet yeah but your patient is a PP R and
your point is
brown oh don't worry he's always like
this it's not personal he doesn't mean
it really just try and make sure that
the next patient you bring down is a bit
better prepared
[Music]
can you just check that probes on her
finger properly for me she's a bit cold
and pale is there any blood Cross Match
for her don't know this doesn't sound
good Dr P you're happy with the
breathing just turn the oxygen up for me
a bit will you please that'll be all
right I'm not happy the blood pressure
is really low is she bleeding typical
Heisenberg butcher James is shut so
there's no way telling what's going on
you want to just hang that bag of s line
up for the time being that'll probably
be all right and do you want to find Mr
ra and see what he wants doing about
those drains okay while I'm gone I'm
going to get a cup of tea anybody else
want anything oh please my please yeah
just milk in mine thanks
okay hasn't Mr H left for the nfield has
he oh probably typical if he
has thank you
Hey Russ you finished already Yes money
for old rope my friend money for old
rope thought i' better sort this mess
out for you lot before I go oh um can
you open the drains and get me two units
of blood yeah sure I said she'd bled a
lot in
theater hello Trey my love come on wake
up now dear do you think you can get her
safely to the ward once she's got some
of the red stuff inside her well I was
going going to give some morphine maybe
give her a PCA you no no no a little
pain never killed anyone you fill her up
with morphine and you'll have to keep
her here let the ward sort that one
out right another life saved wham bam
thank you ma'am I'm off to the pub um
tell Brian I'll see him there in half an
hour thank you
mild are you all
right have you got some pain Mildred
we'll get you some tablets we'll get it
sorted I did try and tell the doctor she
wasn't looking comfortable no patients
look comfortable when they' had major
surgery nurse haven't they taught you
that
yet could you check her band label
please want to give us some
codal mured H yes date of birth 5th of
January 1934 yes unit number 281 359 yes
that's fine
sister it says she's allergic to weed
yes she is she's got celiacs disease
that's why she's on a special diet are
you sure it's just diet I'm positive
it's just diet well they taught us in
school this week and all sorts of things
and I'm sure they mention tablets school
doesn't know everything can you make
sure she takes those tablets we need to
get on
[Music]
mild can you hear me come
on
mild can you hear me
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