Mom recently fell and broke her nose. Although staff at hospital was kind, they have no idea about how to help someone with dementia. All they know how to help with is the medical part of an injury. With all the people suffering from dementia, you'd think there would be more resources from a hospital. Can the ER get specialized training or is that too much to ask?
Emergency rooms exist to treat just that "emergencies"
You are lucky if the MD who finally sees you is actually trained in emergency medicine. Many MDs and RNs work on contract and may rotate between several hospitals within the same group or even work for an agency. They may rotate betweens such area as ICU, ER, and OR.
Coming by ambulance does not necessarily mean you will be seen immediately. I was taken to a major teaching hospital with life threatening symptoms and joined the end of a long line of gurneys. I was fortunate because my transfer had been pre arranged and the wait was only minutes but I wondered about the other gurneys in the line.
Typically if an ER patient needs specialist care for example an orthopedic surgeon as long as the injury is not life threatening the wait can be extremely long especially if he is in the middle of a long surgery.
An obese woman may arrive complaining of belly pains and the nurses do the usual assessments and half an hour later are surprised to hear the crying of a new born. She may have had many children and this time had no idea she was pregnant. Whose fault is it that this was missed?????
I have said this before and say it again. it is very important for every patient to have an advocate who can insist on answers to questions. This is specially important for patients with dementia. A list of current medications is essential so caregivers please carry several copies plus insurance card and paperwork giving information about POA and DNR. In hospital DNR may need to be signed because the one from home may not be effective. As an aside I was invited to sign a DNR in the OR just before being anesthetized. When I declined I was asked what measures I would like taken. Luckily I don't have dementia so I referred them to my husband.
These days hospitals are a jungle and it is most important to advocate for yourself and your loved ones. If you have major allergies or drug interactions wear a medical alert bracelet or failing that write on an arm with magic marker. You can also write on a limb the type of operation you are having. Most hospitals do have good safeguards in place but I would rather be laughed at than have the wrong leg amputated. Remember Drs and nurses are people too and can't know everything.
The earlier comments that "payment status first, the most critical second" are the guidelines is reflective of one person's opinion and not reality.
Anyone who believes that payment status is the priority criteria needs to learn about Hill-Burton hospitals. And do some research on "triage" while you're at it.
Based on what a family member who has qualified as a Level I trauma nurse, and obviously knows more about hospitals than someone who makes unfounded judgments, standards of care established for ERs are established by medical professionals, and are very, very strict. Medical malpractice has factored into this over periods of years, as well as has tort reform. Standards of care exist for specific issues and treatment.
The "financial" and "insurance" "gurus" aren't calling all the shots, by any means.
I wish people who criticize medical professionals would do some research for local college requirements for nurses. The courses are very demanding, extensive knowledge is required, and performance is monitored literally constantly. Staff must be accountable, even when a patient is obnoxious.
Patients and their families can be ignorant, sometimes by choice, and can easily misconstrue situations b/c of that lack of knowledge.
ER staff are the frontline treatment specialists, the ones who need to triage the patients.
But let's not gloss over the fact that family caregivers are often the problem. Often on the verge of burn out, a trip to the ER can send a caregiver over the edge and, unfortunately, the person with dementia picks up on it. So while I agree more training is needed, I think it's caregivers who should be getting it.
While the staff may know about Alzheimer's and various forms of Dementia it is up to you when you bring someone to the ER to inform the staff about the type of dementia and any "special" things that they need to be aware of.
If restraints will be needed inform them immediately so that approval can be obtained. Why insert an IV or a catheter if the patient is going to rip it out if not restrained.
If possible get the Social Worker involved so that if an over night is needed they can help arrange a "sitter" if needed.
Some hospitals have a decal like a purple angel or other logo to place on the chart so staff does not ask the patient questions but will ask family. (sort of ridiculous to ask a person with dementia what meds they are taking or when was the last time they got......???)
ER's are rushed and they are taking care of many at the same time so be patient but be assertive when safety or care is in question.
With any trip to the ER bring copies of POA for health care and if you have it a copy of DNR or POLST. If they do not have a copy it does not exist unless they have it in hand. (I was told this by an ER so I had copies made and kept them in the car as well as extra copies to give to paramedics if transfer was necessary.)
And, yes, I think persons trained in handling those with dementia should be available to consult on each shift! If someone comes in who doesn't speak English the staff calls an interpreter of Hmong or whatever is needed. Why couldn't a dementia behavioral specialist be called for that need?
I think I understand the implications of what we are asking. It would mean not simply a change in how ER staff are trained, but a shift in how ERs are set up and how hospitals run.
That ERs are terrible experience for persons with dementia is well known. This is not to blame the hard-working and dedicated doctors and nurses who staff them.
Hubby was having an episode of gout and his demeanor was calm. But if the pain and unusual environment had caused him to act out and he was given the wrong anti-psychotic it could have produced irreversible harm or been fatal. It happens. My husband's medical record lists those drugs as allergies. It still happens.
There is a great book called "Improving Hospital Care for Persons with Dementia" by Silverstein and Maslow that has some great suggestions. It came out in 2006. Although we know what is wrong and have ideas how to fix it I don't see much improvement.
My suburb has a nationally acclaimed hospital. I've had minor surgery there and I would certainly want to use that hospital again. But they did a piss-poor job when Coy was in there. His doctor suggested that in the future I take him to a down-town hospital with less of a reputation but more experience with elders and therefore with dementia. That really was an improvement.
Also, if at all possible, persons with dementia should be accompanied by a family member at all times. Sad, difficult, but necessary.
By their very nature ER's are not the best places for dementia pts. But, they are a necessity at times. Don't sell the staff short. Most know how trying the visit is on your loved one and on you.
Yes there is a triage, and usually if one comes in by ambulance, they get first priority.... one will also get first priority if you walk into an ER having chest pains. Those who have sore throats or a sprained ankle will need to wait in line.
I have found one gets just as good care at the urgent care type walk-in clinics. We have a lot of those in my immediate area. And if the doctor feels this situation needs a higher level of care, they will call 911. Again, no issues with dementia.