"A number of problems"

About: Box Hill Hospital Monash Medical Centre / Emergency Department

(as a relative),

Earlier this year, my partner was admitted to Box Hill Hospital to undergo a septoplasty and turbinectomy to treat sinus problems. We experienced a number of problems and we would like to share our experience in the hopes that our feedback can be used to create more positive experiences for other patients and their families.

My partner experienced a reaction to the anaesthetic which resulted in extreme nausea and convulsions. After a few hours in recovery, my partner was transferred to the ward.

Our experience with the staff on this ward was not a positive experience. While I was visiting my partner shortly after being transferred to the ward I smelled blood. I looked down and saw the cannula in my partner’s vein had come open and blood was pouring out. I ran to the Nurse’s Station to ask for assistance and the nurse who was photocopying at the time told me to go back and put pressure on the wound. I told them I did not feel comfortable doing that and I asked for a nurse to please come and assist me. The nurse then followed me to my partner’s room and saw that the cannula was open and needed to be fixed immediately. My partner was very groggy at the time and I worry that if I was not there at the time, some time may have passed before someone noticed that the cannula was open and my partner would have lost a lot more blood.

Later that evening, my partner was going to the bathroom and the fluid bag and drip that was attached started to beep and the words ‘Air bubble’ were flashing on the display. My partner and I are aware of the dangers of air bubbles so we pressed the 'Nurse' button and waited for assistance. We were panicking as we thought the threat of an air bubble was imminent so I went next door to try to find a nurse. I saw the nurse on duty and asked her to please help us as we thought it was an emergency. The nurse told me it was the worst time to interrupt nurses as this is the time they are administering medication. We apologised for interrupting and explained that we thought it was an emergency.

My partner ended up staying in hospital overnight due to low blood pressure. The day following the surgery, my partner was not feeling well and was still experiencing dizziness and nausea. Later in the day, the nurse on the ward in the afternoon came in to check on my partner and was taken aback that my partner had not had a shower. My partner didn’t have a shower in the morning because we did not think that was an option given the dizziness and nausea my partner felt while sitting up or walking around. The afternoon nurse suggested it would be fine if we took it slowly and carefully. The nurse also said that the reason my partner was still not feeling well was because they were still in bed feeling sorry for themself. We thought this was pretty rude as my partner was genuinely feeling unwell and we were relying on the expertise of the nursing staff to let us know when/if my partner was fit and able to get up and have a shower.

Once my partner was sitting up after having a shower, we were told it would be best to be discharged and go home. The discharge process was very fast and within an hour or so, my partner was discharged home. We were given a prescription for Endone and directed to take 1 Endone tablet every six hours and 2 Panadol tablets every four to six hours. This was the extent of the pain management information provided. We were also given a nasal spray to use. I asked a number of questions regarding after care. The information provided was very brief.

We arrived home in the evening and my partner started to experience strong pain again. My partner had been given various pain medications throughout the day at the hospital. It was then that I realised that I wasn’t sure the last time my partner had been given Endone or Panadol. I did not want to give my partner too much of either medication so I phoned the ward and explained that we had just been discharged from the hospital and I wanted to know when my partner had last been given each medication so I could administer the pain medication properly. The nurse on the phone was very rude and impatient. She told me she didn’t know and could no longer access this information. She gave me an approximate time and got me off the phone.

My partner experienced significant pain throughout the evening which we tried to manage with the Endone and Panadol as directed. My partner’s pain was not under control. My partner was also experiencing significant difficulty breathing through the nose. We were quite concerned so we traveled to the Emergency Department of the Monash Medical Centre as this is the closest hospital to ourselves. We waited a number of hours and during this time my partner was administered with further pain medication. Emergency Department staff at the Monash Medical Centre were helpful, but were unable to assist us with questions we had about my partner’s nose following the surgery.

We returned home from the Monash Medical Centre in the early hours of the morning and attempted to get some sleep. About an hour later I awoke to my partner in discomfort. My partner had not been able to sleep at all due to breathing difficulties and was very distressed. This was very upsetting for me to see. We then decided to visit the Emergency Department at the Box Hill Hospital to seek further treatment and advice. When we arrived at the Emergency Room we were fortunate enough to receive excellent care from Emergency Department Nurse. We explained the medication plan we had been given and explained that my partner had been unable to breathe through the nose at all. They were reassuring, caring, and patient and they provided us with a lot of helpful information. They explained that my partner was able to take Nurofen, Panadol and Endone throughout the day to ensure that pain was managed. They also explained to us how many of each medication to take and the intervals to take them so that my partner would have the least pain as possible. They were surprised that we had not been given a pain management plan or more thorough instructions than take Endone and Panadol alternatively.

They also explained that it was a normal side effect of the surgery to be unable to breathe through the nose after the surgery and helped to reassure my partner about this. They were very empathetic and sorry that my partner had such a bad experience.

My partner and I waited all day until mid-afternoon so we could see a doctor from the ENT (ear, nose and throat) unit. When we saw the ENT doctor we explained our concerns about the difficulty my partner was experiencing breathing. The ENT doctor was surprised that we were concerned about this because this very common side effect was explained in the information sheet regarding this surgery that is supposed to be given to patients after the surgery. This information sheet includes information about what to expect after the surgery and some advice regarding minimising these side effects. We were not provided this information sheet during my partner’s discharge. We also asked about ways to improve my partner’s breathing and we were given information about a nasal bottle (also included in the information sheet) which assisted to clear up my partner’s nose following the surgery.

I am very disappointed that a simple oversight in following a basic discharge procedure (providing the information sheet and a thorough pain management plan) resulted in significant discomfort and stress for my partner. This lack of basic information resulted in my partner visiting two emergency departments for a total of approximately 17 hours, which used up hospital resources and time and caused us significant distress. If my partner and I were provided with the correct pain management and discharge information, my partner would have avoided a lot of unnecessary distress and discomfort and we would not have used up hospital resources.

When we attended the post-operative review appointment, we explained our experience to the ENT Doctor on call and they suggested putting the after surgery information sheet on the Box Hill Hospital website. We think this would be a great measure to ensure that other patients have the information required and they can access this at any time required.

Responses

Response from Jo Gatehouse, Director, Quality, Planning and Innovation (Acute Health and Consumer Participation and Patient Experience), Eastern Health We are preparing to make a change

picture of Jo Gatehouse

Dear 'concerned partner',

I was very concerned to read your story on Patient Opinion. It appears that your partner and you did not initially receive the high level of care that we aim to provide at Eastern Health and I am sorry that this was your experience.
I would like to be able to investigate the concerns you have raised and invite you to contact me directly via email on jo.gatehouse@easternhealth.org.au so that I can get a few more details from you and follow up with the teams involved. I can reassure you that I will not post any of your personal details on Patient Opinion should you wish to make contact with me.

Your feedback about having patient information accessible on the website is a good idea and we are looking at the best ways to provide information for our patients and their carers. Having said that, best practice would also include providing this information directly to the patient and their carer so that the information can be discussed and explained as required. I am sorry that this did not occur in this instance.

Thank you for sharing your story on Patient Opinion. The information will be passed on to the relevant programs so that we can work towards improving our processes around the provision of information. (I will also ensure that your more positive experience with the Emergency Department Nurse is forwarded to the program).

I would again encourage you to contact me so that the specific teams and staff can receive the appropriate feedback.

I trust that your partner has recovered from the surgery and is well on the road to recovery.

Kind regards,

Jo

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Update posted by concerned partner (a relative)

Thank you Jo. I will send you an email and would be happy to discuss this further. We are hopeful that our experience will result in an update to policy or training so that other people have a better experience. Thank you.

Response from Jo Gatehouse, Director, Quality, Planning and Innovation (Acute Health and Consumer Participation and Patient Experience), Eastern Health We have made a change

picture of Jo Gatehouse

Dear concerned partner,

Thank you for following up with us about your experience at Eastern Health.

Further to discussions with you, we have progressed a number of initiatives to address some of the concerns you highlighted in relation to the provision of patient information for our consumers.

The Program Director of the Surgical Program will send a memo to our surgeons reminding them about the importance of utilising the resources we have available for them to hand to our consumers. Whilst we are exploring the possibility of these information sheets being placed on our external website – many information sheets require a conversation between the clinician and the patient to ensure that questions can be answered and information clarified so this will depend on the content and explanation required.

We have included a list of the new and revised consumer information developed at Eastern Health (with consumers) in our staff online newsletter called Eastern Health Weekly. This is to raise awareness of our published resources more broadly and it provides a link to the older published information lists too.

The Quality Managers of our clinical programs highlight any new consumer information publications at the monthly Quality and Strategy meetings. These meeting have senior staff in attendance who can promote this information to the staff on the ‘ground’.

We have also made evidence based, surgical consumer information sheets available to our staff for dissemination to patients. The surgical specialities information sheets developed by EIDO Healthcare Australia are accessible via a database which we are actively promoting to the surgical team. We receive reports from the company which allow us to monitor the viewings by our staff, so this is a good way to check on their usage.

I do hope all of the above goes some way to reassuring you that we are continuing to work on the dissemination of our valuable consumer information resources.

We also discussed the option of you joining the Eastern Health Consumer Register to help us improve our services. The register members are a mix of consumers, carers and community members who are keen to volunteer their time to help improve our services by participating in planning events, redesign activities, committee membership etc. It is a great way for us to hear the consumer perspective on how we should deliver or improve our services. If you are keen please do not hesitate to email the Centre for Patient Experience: feedback@easternhealth.org.au or ring on the number previously provided or 1800 EASTERN.


Thank you again for helping us to improve the experience of our patients and their loved ones.

Kind Regards,

Jo Gatehouse

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