Oxygen part 3

Today I visited the hospital twice.

At noon, the patient was wondering why nothing had been delivered for breakfast or lunch. She is being tube fed, but for the past several days she has also been getting jello and apple juice.

Two plastic containers of apple juice and one of jello were on her tray, along with 4 more tins of Pulmocare. Her tray was at the foot of the bed, beyond her current reach. She can't even sit up without assistance, partly due to pulling muscles when she fell (the reason she came of the hospital) and partly from 5 weeks of being confined to the bed. She has macular degeneration and can't actually see what's on the tray at that distance. The paper slips showed that one apple juice was for breakfast and another, with the jello, was for lunch. She hadn't known they were there.

"People come and go," she said. "They don't say anything to you, and I can't see what they're doing."

There are eight tins of Pulmocare piled on her bedside drawers, as well as six bottles of Ensure. There are at least 8 more tins beside the sink, and 5 more Ensure. I added the four new tins to the pile. What are they for? The number of tins has been growing - does someone think she's actually ingesting them? At this point, everything but the jello and apple juice is controlled by a machine that pushes it in slow and regular amounts through the feeding tube, so it would have to be the responsibility of someone in the hospital to put the food into the bag suspended from the pole.

I went back at 6:30 pm. I took the chart from the wall and looked at the entries for the 5th of June. There, at 16:45, was an entry showing her oxygen machine set at 3 and her blood oxygen saturation at 97%.

What was missing was that her oxygen had been set below 2 and her saturation was only 75%. The output was raised to 3 and it took several minutes to get the saturation into the 90s.

So I asked to speak to the charge nurse. When she arrived, I asked why the chart was missing this information. The charge nurse told me that she had been told the reason the oxygen reading was only 75% had been because the patient's fingers were cold. A reading from the toe was 97%. So I told her that I knew this version of the story was incorrect, because I had a phone call when it happened. Two readings were taken on different machines, THEN the oxygen machine was turned up to 3 and eventually a 97% was reached. I asked if the previous incidents had been recorded or if they too had been left off the chart. She said she didn't know - but that she had made handwritten notes about the incident on Wednesday (when the oxygen hadn't been hooked up).

I told her the doctor had called us Thursday and he claimed to know nothing of these incidents, so he had been thinking the patient didn't need to be on oxygen - which is certainly what it might look like if you don't have these incidents recorded on the charts. She said there isn't room on the charts for explanations. I pointed out that the initial reading should have been on the chart - because those were the levels she would have been at for several hours.

I asked who I have to go to to report this and make sure it doesn't happen again. She did not tell me.