Hospital Admission Challenges and SCI

Ensuring good care during a hospital visit can be a challenge for people with a spinal cord injury due to their unique, individual needs. George Louw advocates for more accountability among hospital staff

George Louw
By George Louw
8 Min Read

Ensuring good care during a hospital visit can be a challenge for people with a spinal cord injury due to their unique, individual needs. George Louw advocates for more accountability among hospital staff

A good friend with quadriplegia from a spinal cord injury (SCI) recently sent me this e-mail:

“I was admitted to hospital overnight so that a couple of test could be done. Just a precaution, I provided a detailed insight into my condition as a quadriplegic; what I could and couldn’t to do for myself in advance, so I expected the staff to familiarise themselves with how to manage me. We agreed on a turning protocol of every two hours.

“Alas, I was only turned twice in 14 hours. When it came to inserting a Foley catheter, the nursing sister put her gloves on, then disappeared out the ward for a while and came back after handling a few other items with her hands to then insert the catheter. She was not sterile at all anymore.

“When I insisted that she not continue the procedure and use another set of gloves and sterile catheter, her attitude changed for the worse. I realised that I had to stay awake the whole night to ensure self-preservation. It really was a nightmare. The hospital management seem to close ranks on my complaint and it was a while before they took what happened to me seriously.

“Hospitals are not safe spaces for us with spinal cord injury and so keep your eyes open and make sure you exercise your rights.”

Two accounts of negligence are evident: Negligence in the care of a person with quadriplegia, and gross negligence in the performance of a sterile procedure. The third account of hospital management closing ranks could also be construed as being negligent of good governance.

So, what to do?

Let us consider the “easy” negligence first: The abuse of protocol in the performance of a sterile procedure. The first line of action (which my friend did) was to directly confront the nurse preforming the procedure.

Second, lay an immediate complaint with the matron in charge of the ward as the matron is less likely to close ranks with the offending staff member.

Medical litigation for negligence is very prevalent in South Africa, as evidenced by explicit TV and media adverts. Senior hospital staff and management are very aware of the risks associated with litigation. In instances where corroborative evidence of an accusation is lacking, closing of ranks may be attempted, but if the evidence is there for all to see, disciplinary action should take place.

If there were no consequences to the negligence, the matter will usually rest there. If, however, the hospital’s response to the negligence was not satisfactory, report the incident to the doctor that is treating you. The doctor will be sure to escalate the complaint as he is ultimately held accountable for the wellbeing of his patients.

In private hospitals, doctors also are not employed by the hospital, and the hospitals depend on doctors to fill their beds and make use of their services. So, doctors have authority in hospitals, especially if they have a reputation of excellence to uphold. Although doctors are hospital-employed in public hospitals, the senior doctors hold similar authority.

Now, for the more difficult situation of nursing care of a person with SCI, the information sheet in figure 1a and 1b was provided by Ari Seirlis, former CEO of QASA.

Information sheets with action plans such as in figure 1 are a very useful point of departure, but it does not hold anyone accountable.

The action plans at the end of each section must be converted into a nursing activities record for patients with an SCI, where actions are recorded under headings that include time, action, patient status, nurse name, and nurse signature.

The nurse in charge of the patient must understand the assigned duties and be held accountable.

When nursing shifts are changed, the handover must include information sharing so that the newly assigned Nurse also understands the assigned duties and is held accountable. In this way duties are clearly stipulated and the accountable persons are known.

In order to facilitate appropriate hospital care for persons with an SCI, it is recommended that QASA designs a generic “Nursing Activities Record for Patients with SCI” as a supplement to the information in figure 1.

PDF templates of both documents should be placed on the QASA website so that it is available for future admissions of patients with an SCI.

Download the QASA pre-hospital admissions form here

On admission, these documents must be handed to and discussed with the sister in charge of the ward. The responsible sister must participate in completing the information sheet, setting up the action plans per category and creating a dedicated nursing activities record.

As a final word, in all likelihood these lists could be met with resistance in some hospitals, especially where nursing activity records have been digitalised and standardised on electronic devices.

There is no point in losing your temper when this is the case. Be aware that SCI admissions are rare occurrences in most hospitals and staff are not geared up and knowledgeable of your needs.

Therefore, be patient and explain the potential consequences should the routines not be followed, and request supplementing the standard (digital) records with the hard- copy patient with a disability action-plan activities record.

As a last resort, escalate your needs to your attending doctor. Should hospital staff not be accommodating of your needs and serious complications arise as a result, please report this to QASA, for them to escalate the matter.

QASA and rehabilitation hospitals must also advocate for the incorporation of disability- related nursing activities onto electronic recordkeeping devices; not just for patients with an SCI, but also for strokes and other causes of mobility impairment. However, the diversity of needs is so great that the possibility of patient-specific free-text options on the devices should be considered.

From all angles, routine admissions of patients with mobility impairments have many and diverse issues that fall outside routine nursing care. Patience and a friendly but assertive attitude will, in the long run, achieve more than throwing your toys around would.

Share This Article
George Louw
Health Administration
Follow:
Ida’s Corner is a regular column by George Louw, who qualified as a medical doctor, but, due to a progressing spastic paralysis, chose a career in health administration. The column is named after Ida Hlongwa, who worked as caregiver for Ari Seirlis for 20 years. Her charm, smile, commitment, quality care and sacrifice set the bar incredibly high for the caregiving fraternity. email: yorslo@icloud.com
Leave a Comment

Leave a Reply

Your email address will not be published. Required fields are marked *

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.