Hi,
This is a scenario which happened to my supervisor on my last placement. There was an elderly lady who was admitted to hospital with pneumonia. She was given IV antibiotics which helped markedly and once her infection was under control the doctors wanted to send her home asap. They asked my supervisor one afternoon just before we finished work whether she thought the lady was safe for d/c on that particular day. My supervisor assessed the pt and reported back to the doctors that she was very unsteady on her feet and was not safe to be sent home where she lived by herself. The doctors said OK and we left for the day.
When we returned the following morning we discovered that the pt had been sent home after we had left. My supervisor was really angry and questioned why the doctor had asked for her to Ax the pt and then ignore her advice.
Has anyone had similar experiences where other members of the multi-disciplinary team do not listen to others input?
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4 comments:
I can completely relate to what you have experienced first hand. I was recently on my general surgery placement and had a patient on the ward for rehab. He had had a failed gastric banding procedure had spent numerous time in ICU and was progressing niceley despite the initial complications which stood in the way of his rehab. My supervisor was treating him daily and was quite happy with his progress. However the reason he was on the ward in the first place was because he was over 120kg and no other facility could accommodate for him. Physio's goals were to continue with rehab until pt was independant with all bed mobility, transfers and amb with wzf independantly...the medical team's goals: lie about the pt's weight and handball him off to someone else. However my supervisor did get the last laugh as this pt was discharged last week independantly and safe in terms of mobility.
I also had a similar experience during my 3rd prac. I was on ortho inpatient seeing a patient who had a conservative management of his tibia or ankle ( can't remember exactly now), he was allowed WB as tolerated. I saw him a few times with a supervisor, we did bed exercises, standing exercises, however as he continued having plaster and later splinter changed/modified, we were unable to try any weight bearing with crutches with him. He was fit to go home apart from physio point of view and also the plaster part. Finally one day his plaster/splint was finalised, so we tried crutches with him on the ward and partial weight bearing of the affected leg. He didn't like it too much complaining weakness of unaffected leg and heaviness of affected leg. He only completed about 20m with crutches. So we decided to try stairs the day after as stairs is a D/C requirement for a mid-aged, otherwise fit gentlemen. There is a communciation board in the nurses room indicating if the patient is fit to charge from all of the multidisciplinary team. We did not indicate that he was ready for discharge and in the notes written that he is not fit for D/C yet. However the next day, when I went to check up on him, was surprised to see that he had been discharged in that afternoon without even trying the stair.
For cases like these, I guess we have to make our point of view clear that they are not ready for D/C to doctors and indicate clearly in the notes as such. If the doctor discharged patient regarless, then we have a back up that patient was discharged without physio acknowledgement if anything bad happen
hi yeh im on international placement at the moment and i had a very similar experience just a few days ago. a lady came in with OA of both her hip and knee, and was severely deconditioned. her berg balance score was 4/56. so as you can imagine, she had a pretty high falls risk. the plan was for some ongoing physio as an inpatient. the day we came up to the ward and she had been discharged, despite all her abilities (or lack thereof) being listed in the notes the previous day. its frustrating, but if we want to change things, we pretty much have to just go do medicine.
Unfortunately I think this happens too often. I was treating an elective orthopaedic patient following an elective left total knee replacement (TKR). She had had a right TKR previously, was obese and had a low intellect. She was making extremely slow progress with her exercises, and was not motivated to perform them independently. Medical staff were pushing to send her home and although she had just met the criteria for discharge from a physio point of view, the team of physios working with her felt that her ROM and strength would deteriorate should she be sent home as she was not eligible for the home physiotherapy services offered to some patients following this type of surgery as she had fallen off the clinical pathway (discharged 12days post op, rather than 6-7). Despite their opinions the patient was sent home with approximately 70°of active/ assisted knee flexion and a quads lag of 20°. When she was then followed up in outpatient physiotherapy 4 days following discharge she was reported to have 55° active/ assisted knee flexion and still a quads lag of 20°. I left the placement before receiving any more word of the situation but clearly the medical team should have listened to the physio’s in this case.
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