My first placement

Before I started my nurse training, I didn't have any real experience of hospitals. I'd seen my granddad in one plenty of times, and I'd worked a domestic in a nursing home, but that was about it. But hey, I'd watched Holby City for years - what more experience did I need? *grin*

My first placement went really well. I seemed to just soak up skills and experience. By the end of the first weeks I was giving bed baths, changing dressings, writing in care plans - the works. I thought I was the business.

On my last day, I was sent off to do the obs round. I got to one man who needed a lying + standing blood pressure. I didn't really know why (of course I didn't really know anything except how to attach the cuff and spot if the result was abnormal!), but I started doing it anyway. Loads of patients on this ward had to have them done, I still don't understand why and I doubt the staff there did either. Anyway, the lying part was fine, but then I tried to get him out of bed to stand him up, and there was just no way that was happening.

I'd looked after him loads of times before, and so I knew he could stand up easily by himself. In my naivité, I asked one of the nurses to help me stand him up. She saw at twenty paces that that wasn't going to happen.

I know now that the man had septicaemia. In fact, he'd become very ill indeed. Throughout the rest of the shift, me and the nurse did various things to him - checked his obs, did an ECG, tried to listen to his heart with a stethoscope to see if there was an apex-radial deficit (surprisingly I did know what this was all about, having happened to read about it in a book a couple of days before. I've never had to use it ever again and I doubt I ever will!). Doctors came and went, taking blood tests. He had a chest x-ray. Towards the end of the shift, he looked quite ill, he was having rigors, was photophobic and had a stiff neck.

I don't know what happened to him, but I'll bet any money you like he died at some point over the next 2-3 days. I didn't realise at the time the seriousness of what was going on. I don't think the nurses did either, or at least they didn't show it. The very junior doctor (he'd been out of med school about 3 months) stayed around for the diagnostic challenge, but having satisfied himself that the patient was indeed ill, he buggered off, and nobody else saw him for the rest of the shift.

I know now that this is a classic scenario, occuring on wards up and down the country every day. Patients who show clear signs of deterioration are ignored, or inadequately treated. They deteriorate to the point where it is so obvious that they are ill that they are sent to intensive care, or they have a cardiac arrest. Either way they die - in ICU it's slowly and painfully, if they arrest it's quickly with someone bouncing up and down on their chest. Neither is particularly pleasant, and both can often be avoided. Report after report from the National Patient Safety Agency and the Department of Health shows this happening, NICE issues guidelines to prevent it, but still it goes on.

Thinking back, I'm horrified. I think it was the realisation, 2 or 3 months later, of what I'd seen happen with this man, that prompted my interest in critical care. It's not all about big dramatic emergencies (cool as they seem to a beginner, you tire of them after a while), the best care is often about little things done at the right time. This applies every bit as much to monitoring patients as it does to keeping them well-fed. Sadly, in nursing, neither seems to happen very well.

Welcome

This annoys me

On the face of it, yes it's excellent. A wonderful idea. Patients will be diagnosed quicker, and thousands of unnecessary trips to hospital will be saved.

Now let's look a little deeper...

Ignoring the fact that I've yet to come across a practice without access to a normal ECG machine, see if you can spot some of the other flaws in the article... here are a few I noticed:

• Why is it that GPs are unable to recognise ECG changes diagnostic of an MI (heart attack)? Of course, they can - anybody with even a rudimentary knowledge of ECGs can identify such diagnostic criteria. So before we even look any closer, we see that the basic premise of the article is flawed (no doubt cynics such as Dr Crippen would say this was a purposeful tactic by the BBC!)
  
• The BBC's 'Health Correspondent' also seems to be unaware that the lack of ECG changes can't rule out MI, and so in anybody presenting with symptoms who is judged to be at all at risk needs to go to hospital for serial ECGs, monitoring and a 12 hour troponin test (amongst many other things)
• Even if you see no diagnostic changes, there is no clinical suspicion of MI, any patient presenting with a sudden onset of breathlessness or chest pain or any of the other symptoms of MI is reasonably likely to need a chest x-ray, and so will end up going to hospital anyway.

So, we can conclude that this wonderful device trumpeted by the BBC is 1) Solving a problem that doesn't exist and 2) Only capable of keeping patients away from hospital when there is no real risk of anything serious (ie those in which an ECG may well have been unnecessary for anything other than covering-arse purposes)

Not that any of that lets the BBC get in the way of a good story!