Oxygen part 10

Today I brought the patient the stimulating circular from the pension plan, the free 2010 Agenda courtesy of Our Canada (she tried to give it to me, but I said she would need to write her future botox dates in it...), and the Land's End catalogue.

When I came in, the bed was at 25 degrees. It had been lowered to that angle and the person who lowered it had gone away, promising to be right back to finish whatever needed doing. "How long ago was that?" I asked. "Oh, ages. They go away and they take their breaks and whatnot and sometimes it's hours." In the meantime, the patient was trying to eat jello.

I reminded her that the bed was supposed to be kept at a higher angle to prevent reflux because of her inability to close the esophagus. We still have the sign on the wall, and by now I feel as if the patient is alert and healthy enough that she should be able to find the controls on the bed and raise it herself. I do it.

She showed me the special socks that had arrived along with the Alberta Health Services feedback brochure. The socks are very nice - supersoft fuzzy taupe with rubbery treads. The misplaced comma on the inside of the brochure made me cranky.

There is a 3-step process if a patient has a concern.

"What concern?" Marie asks. "Do I have a concern?"

I can't tell if she's joking or not. "Do you have concerns about the way things have been done here?"

"Don't get me started," she says.

Step 1 is to discuss the concerns with the team. Okay - so we did that with the issues of the oxygen and the suctioned fluid and the bed angle. And although none of these things was resolved quickly, over the course of several weeks we seem to have gotten to the point where only the bed angle is still not understood.

Step 2 is to contact Patient Relations if Step 1 has failed to resolve the concern. Now, think about this: Patient Relations. The text of the brochure makes it clear that everything is about the patient's concern. The message I get when I look at this brochure is that the patient has a problem, not that there is a problem the hospital needs to address. So if we had gone to Patient Relations with our problems - the understaffing of the unit, the dangerous mistakes regarding oxygen and the bed angles, the peculiar performance of food services - what exactly could they have done? These are not individual problems; they are problems with the system. As such, they are not "patient concerns"; they should be seen as concerns of the hospital administration.

Step 3 is to contact the Deputy Patient Concerns Officer if the other steps have not resolved the concern. If that doesn't work, you can go to the Alberta Ombudsman Office with your question or concern about the fairness of the Deputy.

Now, let's look at this process again.

A patient - presumably someone who is sick enough to require hospital care - not only has to deal with their care team over the thing that is wrong (we'll call it a "concern" if it makes everyone feel better, but I don't consider repeated failure to provide necessary care a mere "concern"), but they then are expected to take the initiative to go through two more levels to follow-up on their concern. Sounds like a lot of work to get the staff to agree that oxygen needs to be turned on and connected.

On the plus side, today I almost bumped into one of the staff who has given me the cold shoulder since the first oxygen incident. We were both surprised enough to smile. Maybe she understands that my "concern" was about a situation, not about the performance of one person.