Saturday, 9 January 2010

Tackling The Mental Health Minefield Part 7 - The GTN Story

(This post continues the story from Tackling The Mental Health Minefield Part 6 - Throwing The Christian To The Lions)

In one of the earlier posts in this series (Part 2 - The Admission Process) I wrote about many of my possessions being taken away when I was admitted to hospital. One of these was my GTN spray, which is prescribed for me because I have Prinzmetal's angina. Prinzmetal's is also known as variant angina and is relatively rare in comparison to the other forms of angina. The pain is caused by one of the arteries in the heart going into spasm, and can occur at any time, even when at rest, and is not caused by exercise and a cardiac stress test cannot be used to diagnose it. I had suffered from its symptoms for a number of years before it was diagnosed and since then daily medication has kept it pretty much under control although I do still have occasional attacks and I always carry a GTN spray to reduce the pain. No matter how hard I argued with the nurse that I should keep the GTN spray, he would not accept that and I was told that if I had an attack that I was to go to a nurse who would get my GTN spray out of the drugs cupboard in the Clinic Room.

I had been in hospital about six days when, early in the evening, I had an angina attack. I was in the communal/dining area, so I walked calmly to the office at the end of the corridor and having knocked on the door and it been answered I explained that I was having an angina attack. The nurse who had answered the door immediately picked up the keys for the Clinic Room and for the drugs cupboard and ran to open up while I calmly walked to meet her. By the time that I got into the Clinic Room she had my GTN spray out of the cupboard and ready for me to use. After taking the usual two puffs under the tongue I sat down on the chair for a couple of minutes to make sure that the GTN spray was doing its work. One of the side-effects of the spray is that it can cause one to become light-headed or occasionally very dizzy, so it is always advisable to sit down for a few minutes after using it.

After about five minutes I was feeling much better and the pain had gone so I went back to the communal area to rejoin the three patients that I had been sitting with. Sometimes after having the angina pain I have a repeat attack about an hour or so later and that is exactly what happened on this occasion. This time one of the other patients went to the office to call a member of staff and the process was repeated. After the second attack, I went to my room and laid down for a while. I was fine, and the next day things were back to normal.

A couple of days later I was moved to my permanent ward and before I left the Admissions Ward I had to make sure that my GTN spray was removed from the drugs cupboard and made the move with me. Once again during the admission process to the new ward I asked that I be allowed to keep the GTN spray with me. Once again the answer was no, but to make matters worse the nurse had to ask what it was for.

Life on the ward continued with no further attacks until the day that I was supposed to be having a couple of hours home leave. This was the occasion when I had an argument with the staff about what my consultant had said about me having home leave (see Tackling The Mental Health Minefield Part 6 - Throwing The Christian To The Lions). I'm not sure that it was the argument with the staff that caused me to have an angina attack, or whether it was just one of those coincidences that happen occasionally.

After lunch I was sitting quietly in my room doing a crossword puzzle when an angina attack started.
My room was just a matter of yards from the ward office so I made my way there, knocked on the door, and the nurse who was in there answered the door and I told her I was having an angina attack and that I needed my GTN spray. The clinic room with the drugs trolley was next door to the office, but the nurse headed off along the corridor towards the communal area rather than going to the clinic room. When I shouted at her that I needed the spray immediately, she said that she needed to find another nurse because there had to be two of them to dispense drugs. I'm afraid at this point I really lost my temper and shouted so loudly that patients and staff came running from all directions.

At this point the nurse decided that perhaps she had better get the spray for me so I followed her into the clinic and waited while she fumbled with the keys to the drugs trolley. Then there was the problem that she didn't know what she was looking for, so I just snatched it from the trolley myself and sprayed twice under my tongue. I sat down on the chair which was used by the patients when obs were being done, laid back and closed my eyes for a few seconds while I waited for the GTN to take effect. Of course there was rather a large audience for what followed and the nurse was still more interested in finding a second nurse than in ensuring that I was okay.

The ward SHO had heard all the noise and came out of her office to see what was happening. Seeing everyone standing around the clinic doorway at a time when no medication would normally be dispensed alerted her that something untoward may have occurred and that she may be needed so made her way along the corridor (I was told about this later by one of the other patients). The SHO came into the clinic and asked what had happened and the nurse said that I had come to the office complaining of chest pains and that she had tried to find another nurse so that they could get my GTN spray together. The doctor was appalled, and proceeded to ask the nurse whether she would have gone looking for another nurse if she had found me lying in the corridor and not breathing. It being a question which did not need an answer, the doctor continued by saying that in the event of something like this happening then the nurse should ignore normal procedures and give an angina patient their GTN spray immediately.

While this was going on, I was just sitting in the chair waiting for the pains to stop. After about 10 minutes, with me still experiencing pain and being monitored by the doctor, it became necessary for me to use the spray again. This time it seemed to do the trick because a few minutes later I was feeling much better and was able to stand and walk back to my room after having had the spray again locked up in the drugs trolley. The SHO came to see me about half an hour later and asked me to go along to her room so that she could carry out an ECG. this turned out to be another farce. First of all, the ECG machine belonging to the ward was not working so one had to be borrowed from another ward. One this had been procured I climbed onto the examination couch and the doctor proceeded to attach the sticky pads to my body and the various leads to the sticky pads. It was a bit like watching someone trying to put together a piece of flat-pack furniture. The doctor stood there with the instruction manual in one had and was attaching everything with the other hand. Every time she attached a lead, one of the sticky pads on another part of my anatomy would come unstuck. Eventually she managed to get all 12 pads attached to my body and all 12 leads attached to the pads. Then she pressed the 'Go' button on the ECG machine ...... and nothing happened. After about half a dozen attempts she decided that it was all far too difficult for her and decided that I seemed to be recovering quite well and the ECG could wait.

The decision was made that because of the angina attack I should not go home on leave that day and the situation would be reviewed in the morning. I asked that I be allowed to keep my GTN spray with me and the doctor agreed, but the nurse wanted it written on my medical records and as the doctor failed to do this she would not give it back to me.

The next day arrangements were made for me to have an ECG in the main hospital, the grounds of which the mental hospital was sited. The ECG was done immediately and I went back to the ward to collect my belongings and my medication so that I could go on my overnight home leave. Although this leave was for one night only I was required to take all of my belongings with me. As I said earlier in this series of posts, and in a post at the time, the home leave was not a success. I didn't sleep at all that night and when I reported back to the ward at lunchtime it was to find that someone had been put into the room that I had been occupying.

At ward round that afternoon it was decided that I was not fit to be discharged and that I was to stay in the hospital. At the same time, the consultant said that I was to retain my GTN spray so that I could administer it myself immediately if I needed to and asked only that I inform the staff that I had used it. I had two further attacks while I was an inpatient, both of which I was able to control immediately because I had my spray.

What the episode of the GTN spray taught me was that you really don't want to be in a mental hospital if you also have a non-mental illness. I would hate to be an asthmatic having a serious attack, or someone having a heart attack, in a mental hospital because if it were staffed with nurses of the calibre of the one who I had the misfortune to encounter, your chances of surviving the attack could be severely compromised.

To be continued.


Bippidee said...

Goodness, that is awful. I am sure that when I have been in hospital I have been allowed to keep my asthma inhalers - at least I don't remember them being taken away, and I am sure I would remember that. Obviously they have to be careful with meds etc, but there are limits, and you would think that basic common sense could come into play, and allow people to keep things that they really need, like your GTN, and inhalers etc.

talesofacrazypsychmajor said...

Ridiculous that you went through that, but sadly not at all surprising.

BenefitScroungingScum said...

Words fail me, but sadly I'm not surprised to hear of this.

Hope your knee is doing better today & you're snuggled up warm! BG Xx

Anonymous said...

This sounds absolutely ridiculous and something I would consider making a written complaint about. Reading this though makes a good learning thing for myself. I would like to thing in a situation like this I would use my initiative over following ward rules if a patient was taken sick!

Achelois said...

If I didn't know this scenario were true it would sound like the beginnings of an excerpt from a new bad taste medical comedy drama type show!

Hoping your knee pain has eased a little and unike me right now you are sleeping soundly and wake feeling refreshed and ready to tackle the essay.

Take care

Zarathustra said...

A sorry tale.

This sort of thing is partly down to stupidity, and partly down to the British system of specialisation in nurse training.

In most countries you qualify as a nurse, but in Britain you qualify as a mental health nurse, or a general nurse, a sick childrens nurse or a learning disabilities nurse. The result is that those in their respective branches often don't know a great deal about the others - mental health nurses tend to have a poor knowledge of physical health, general nurses don't know a lot about psychiatry, and so on. Admittedly there's advantages to the system too - in Australia they abandoned specialisation in nurse training in favour of a generic qualification, and as a result found themselves trying to staff MH wards with nurses who could look after your trachaeostomy but knew next to nothing about mental health - but I'm digressing.

As is so often the case, it looks like in the absence of knowledge the nurses fell back on procedure and protocol - "all medication has to be locked in the drug trolley", "two nurses should administer the meds together".

But common sense should come into it as well. If a patient with a history of heart problems starts having chest pains, that's not the time to worry about having a second nurse to administer the meds. Lord knows there's plenty of times when I've done the regular drug round on my own because there simply wasn't another RMN available.

Ophelia said...

Ah.. its not just the NHS. When I was admitted to a mental health unit here in Australia, they withheld all of meds until I could see the Admitting Psych. I understand, I guess with the Psych Meds, if they are reviewing the medications, but if you put my 8pm dose of epilepsy meds off till 1am, there is a damn good chance I'll have a seizure... won't that be fun for all of us? Common Sense, a lacking commodity.

Zarathustra said...

On the subject of common sense, if the SHO is physically on the ward at the time, why didn't the nurse ask a nursing assistant or one of the other patients to bang on the doctor's office door? It's what I'd have done.

steph said...

Sorry to hear you were put through all of that hospital policy nonsense.

Your story raises another question for me. Surely if the wards in Mental Health hospitals are equipped with ECG machines, then the medical staff should be trained to use them?