Surviving Healthcare At The UHN

A patient's inside view of the UHN

Yes,there is sugar in hemodialysis dialysate…

Yes, hemodialysis dialysate does have sugar in it.

No, we are not confusing it with peritoneal dialysis dialysate. Your nurse & even your doctor might be telling you this but oddly enough, they’re wrong.

Even though this link is for Fresenius’ GranuFlo,it does represent most hemodialysis dialysate out there in terms of sugar/dextrose/glucose content.

http://www.fmcna-concentrates.com/concentrate_new_content/best_practices/BestPracticesinDialysateComposition.pdf

If you are curious to the content of yours, look on the ingredient list of the potassium wash jug used for your dialysis. Some potassium washes come with a different potassium content…but sometimes there is also a higher glucose content. They can come in varying combinations of different levels of potassium & glucose. It pays to know, because even though the glucose levels in the dialysate aren’t supposed to, theoretically, affect blood sugar levels, they can, especially if one happens to an insulin-dependent diabetic. If you are & your blood sugars are inexplicably rising, time to check your dialysate….

Update: Accessibility & Policies 2012/08/15

Due to some hopefully technical difficulties with access to the accessibility policy, here’s one to help everyone along:

AODA-UHN-Policy-03252010

Got clean?

This is the Big Whopper coming at you with another whopper….

http://news.nationalpost.com/2014/01/26/superbugs/

In short, this is supposed to be another miracle solution to clean hospital environments, this time in the shape of a sort of disinfecting roach bomb.

Note the bit where a member of the esteemed establishment in our main title is purporting that the current approach is scrubbing the rooms. An interesting approach, especially as of yet we have yet to see any scrubbing….or cleaning. In all the time we’ve spent in various parts of it, we’ve seen the partition curtains taken down and washed once. Once. And by the sounds of the staff opinions at the time,it was a big deal. Cleaning as it is usually understood is indeed in short supply there. Whether it is cleaning rooms between patients or while a patient is still in hospital, it is equally lacking. I remember when Big Mac was in hospital & threw up a bit in the bathroom sink. He couldn’t help it, the antibiotics he was given as a precaution were the same ones we told them he can’t take, his stomach can’t handle it anymore. That’s not the story…the story is that after 3 days that sink still had the detritus dried in it, until Big Mac’s mom noticed it & raised hell with housekeeping. Scrubbing indeed….

Now I have it on good word from a reliable contemporary source that this was not how it used to be. Rooms did indeed used to be scrubbed from top to bottom after a patient left, bed, table, nightstand, floor & even the walls scrubbed & bleached, bedlinens & dividing curtains taken down & laundered in the on-site hospital laundry….whereas the best we’ve ever seen was the ubiquitous disinfectant-soaked rag (‘cloth’ does it no justice) swiped at the most often touched surfaces. Nothing is actually cleaned let alone scrubbed. The leftover glue patches from tape gathering black dust & the ground-in dirt in other surfaces bear sad testimony.

The problem is that cleaning has become an oxymoron in the presence of antibacterial advancements….here’s why:

Disinfect: 1. clean (something) with a disinfectant in order to destroy bacteria

Clean: to make clean: as (1)   :  to rid of dirt, impurities, or extraneous matter 

But now it has become common place to disinfect without actually cleaning. And therein lies the crux of the problem. We now have reached the state of disinfected dirt. Is that clean? Is that hygienic? Is that acceptable ?

I find this new gas approach scary. What are they going to do now? instead of cleaning at all, just disinfect the room, dirt & all??

We are now back to pre-Semmelweiss times. Be afraid of having to go to the hospital, you might get sick & die from having caught an infection in hospital. Rooms aren’t cleaned, common areas aren’t cleaned, staff don’t wash their hands…pretty soon we’ll be back to 2 patients per bed.

But it’s for our own good. They are doing such a good job. They are improving every day. Such amazing innovations to keep hospitals up to date on cleanliness. Perhaps one day they will catch up with the sixties.

Poor Semmelweiss. Must be doing Immelmans in his grave by now….

Critline use

Critline use

Here is the professionals’ manual for using a Crit-line monitor. Once again…critline is a very efficient way of doing hemodialysis without all the ‘normal’ side-effects. Low BPs, cramps, fluid off too fast, not enough fluid taken off, too much fluid taken off…all can be prevented by the use of a critline. You need no longer wait until you ‘crash’ with dizziness & low blood pressure or excruciating cramps and you no longer need to guess at how much fluid to remove by ‘dry’ weight. Proper use of a critline can predict a BP crash or cramps caused by too quick or too much fluid removal & prevent leaving ‘wet’. It’s easy to use/read, a patient can use it just as easily as a nurse.

Educate yourselves!

Breast cancer survivor becomes first patient to undergo surgery at new Women’s College out-patient facility

Outpatient surgery….Doesn’t that sound scary?
‘This reduces the risk of infection’….in other words,they are laying the onus of cleanliness at the patients’ door,after hospitals are proving to be unable to provide an infection-free (or at least low-infection-rate) zone.They can’t even enforce a simple handwashing rule,which,quite frankly,in hospitals,should be mandatory and a lack of it should be a discipline offense.It also shows the growing trend of leaving patient care in the patients’ hands.Less inpatients,less nurses to pay for…because,of course,patients care for themselves,or relatives will care for them–for free (not to mention that what nurses do nowadays,is not actually patient CARE).

This is also the reason they push for home dialysis…so much cheaper to leave the patient and their care-partners to play the role of tech/housekeeping/repairman/nurse rolled all into one & all for free than to actually maintain a proper hemodialysis unit.
This is a very disturbing trend. It leaves no medical professional responsible for anything.

And once you as the patient leave the hospital, you stop being part of their ‘adverse event statistics’. You go home and drop dead from an unforeseen reaction and it doesn’t go on the hospital statistics. Anything happens after the surgery but at home,not only will it not go on their statistics,but it will somehow be your fault as the patient.
We need more supervision,transparency & overseeing in the healthcare profession,more accountability & responsibility for mistakes & negligence. Yet the plea to have the Ontario Ombudsman be able to handle hospital complaints (which they get anyway,from patients who have nowhere else to turn as there is NO complaints and appeal policy at all…all patients are left at the mercy of autonomous hospitals with no avenue of redress) was thrown out yet again. The proposed Patient Bill of Rights has been turned down again and again.
Woe is the patient….

National Post | News

Caroline Noakes is looking forward to getting back to normal.

The 30-year-old was diagnosed with breast cancer over a year ago. She had the tumor removed and underwent chemotherapy, but also found out she had a variant of the BRCA1 gene – the same gene Angelina Jolie recently said she carries. Though experts don’t know if Ms. Noakes’ gene is a variant that causes cancer, she chose to undergo a preventative double mastectomy at Women’s College Hospital in December.

“I just decided that I didn’t want to go through [cancer] again,” she said, adding that her chances of having breast cancer again have now rapidly dropped.

On Monday, she was the first patient to undergo surgery at Women’s College Hospital’s new facility at 76 Grenville St. in Toronto. This surgery was for breast reconstruction.

“It does hold a special place to be that first patient,” Ms. Noakes said. Women’s College…

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Watch out for the curve…

In case anybody hasn’t seen this yet:

http://www.cbc.ca/news/health/features/ratemyhospital/hospitalratings.html

It’s a wonderful article on how well Canadian hospitals rated. Not surprisingly,the UHN overall only got Cs…on the other hand,surprisingly,it managed to get Cs.Frankly,it ought to have been at least a D,especially when it comes to cleanliness & quality of nursing care,medical attention,respecting the patient,attitude,responsibility,truthfulness….you know,professional medical care. Love how their handwashing compliance is magically 87%…must’ve been graded on a curve or something. Love the pain assessment bit,too…especially when I recall waiting over 3 hours for an extra-strength Tylenol after an operation in a ward plastered with ‘We won’t let you suffer’ pain control posters (this after having buzzed the nurse for one,only to have the buzzer turned off on me,having then to send my friend to find my nurse,be told nurse is on break,be told covering nurse will bring one,wait 3 hours—finally gave up & had my friend go get me a bottle of Tylenol).

Anyhow,browse through it & when you come across your own friendly neighborhood hospital,click on it—there’s a rating function built right in.Have your say!!

Don’t let others say it for you…that’s how we got in this mess in the first place.

You have got to be kidding!

This is what the dialysis nurses are SUPPOSED to be doing…..???

Adapt from nephrology nursing practice recommendations developed by Canadian Association of Nephrology and Technology (CANNT) based on best available evidence and clinical practice guidelines, a nephrology nurse should perform:[30]

Hemodialysis Vascular Access: Assess the fistula/graft and arm before, after each dialysis or every shift: the access flow, complications Assess the complication of central venous catheter: the tip placement, exit site, complications document and notify appropriate health care provider regarding any concerns. educates the patient with appropriate cleaning of fistula/graft and exit site; with recognizing and reporting signs and symptoms of infection and complication.

Hemodialysis adequacy: Assesses patient constantly for signs and symptoms of inadequate dialysis. Assesses possible causes of inadequate dialysis. Educations patients the importance of receiving adequate dialysis.

Hemodialysis treatment and complications: Performs head to toe physical assessment before, during and after hemodialysis regarding complications and access’s security. Confirm and deliver dialysis prescription after review most update lab results. Address any concerns of the patient and educate patient when recognizing the learning gap.

Medication management and infection control practice: Collaborate with the patient to develop a medication regimen. Follow infection control guidelines as per unit protocol.

My sincerest,highest regards to the few & inbetween,precious-as-gold nurses who DO do this (you know who you are!).

But quite frankly,the rest…either they don’t know how to do most of this–or just plain don’t care,both about the quality of their work or the health,wellbeing & safety of their patients. Assess cause of anything? Or even acknowledge something is wrong instead of brushing it off as “it’s ok”? Educate?? About anything?Review most up to date lab results? When sometimes they don’t do PRU calculations for months? And when they do do them,it takes them 2 weeks from getting the bloodwork results to doing a simple PRU calculation? Or when nobody ever checks biweekly bloodworks because they’re not in the paper chart?!!  Recognize the signs of inadequate dialysis? They blame everything under the sun on ‘inadequate dialysis’ except actual inadequate dialysis.That one is the patient’s fault,now,isn’t it.

Patients,take heed,this is what you’re missing.

Your CARE.

Fight for it.

How much less is a leg?

Anybody out there have this problem?
Clinics & doctors like to use BMI measurements to assess body weight.Now,the standard BMI calculators might work well if you have all your body parts.But what about those who are missing one? How does one calculate BMI for some one missing a leg? An arm? Part of one? Both?
Usually when this question comes up and the amputee patient is,quite relevantly,asking how does the missing body part affect the BMI,they get told it doesn’t matter or get the ‘you have three heads!!’ look. Not very helpful.
Hopefully,this is:
http://touchcalc.com/calculators/bmi_amputation
This is a BMI calculator that actually lets you input what kind & degree of amputation to calculate with.

Update to “Blood Volume” Aug 8,2012

In the post mentioned in the title,there was a link posted to a very useful PDF for blood volume monitoring during hemo-dialysis.Unfortunately,since Fresenius bought out both Hemametrics & Crit-line,that & other such links have become defunct.
However,here’s a similar link.It’s a bit more juvenile than the original link (seeing as that one was aimed at staff,not patients),but is still servicable.

http://www.esrdnetwork.org/assets/pdf/patients/patient-edu/2012/Patient_Booklet_Critline.pdf

On the plus side,it’s clearly aimed at the patient,so feel free to print it out and show it to the hemo staff in charge of your care.

Blood volume monitoring during dialysis is very useful.It can be used to avoid dehydration,low blood pressures,cramps,’crashes’,lessen the sick/washed-out/nauseous post-dialysis side-effect & it can also be used to make sure you’re not carrying extra water around.

‘Facepalm’

So….

They’ve recently put up the new hospital maps and orientation boards all over the TGH.

Beautiful new shiny colorful maps,who knows who thought them up because some of the things on them no patient will ever need to know where it is….like Nutrition Administration.In more than 7 years,that might be the only place in the entire hospital that I haven’t needed to know about. Now…the Privacy Commissioner’s office,now,which,by the way,happens to be in a nook BEHIND the Nutrition Administration’s office,yes. This is a very useful thing to know.If you want to know anything about how the hospital runs,how much they’re spending & who gets paid how much,anything that’s public information,this is where you go. Why is this not marked on the map that’s on the wall right next to the Nutrition office?Why is there no sign next to the door of the Privacy office or even an arrow pointed that way? (And trust me,I know,we spent an hour asking various information desks to find our way!Well-hidden,eh?)…insert preferred conspiracy idea here.

Anyhow,all these pretty new,probably costly (see,the Privacy office could come in handy yet!) signs…..and they mis-spelled Administration.

Yep.

It proudly,bright-and-clearly says Nutrition ADMINISTATION. On more than one map.

Hence today’s word: *facepalm*.

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