Aniello Iannuzzi: Heavy lifting

UNTIL that moment, it felt like any other day — morning walk, breakfast, shower and off to do a ward round.

Then I picked up the bedside chart of Mr X in Room 3. “Hmm”, I thought. “This feels a little heavier than usual.”

I opened the folder to be confronted by an 11-page document on the handling and disposal of cytotoxic drugs.

Now, you must be thinking Room 3 is in the oncology ward or the patient has some grave malignancy. You can imagine me wearing a special purple gown, mask and gloves.

Nope!

Mr X is having rehabilitation after a hip fracture. He takes one methotrexate tablet a week for rheumatoid arthritis — a tablet that he normally collects from his community pharmacy and takes on his own at home.

The intrusion of the mega protocol into what should have been a routine morning round made me mull over matters. I realised that over the past few years bigger biceps are required to handle bedside charts.

As a rural doctor, I need to see the essentials in the bedside chart; namely, observations (BP, pulse, temperature, oxygen saturation, blood sugar level and urine output) and medications (what’s been given, if they’ve been given and when).

Pardon my candour Mr Beuro Krat, but I feel other documents can go in the full patient chart at the ward office.

Modern bedside charts are a forest of papers and laminates. The chart pictured (below) shows what is mandatory in our small rural hospital. I imagine bigger hospitals with sicker patients have even more items on their charts.

Since the introduction of the National Inpatient Medication Chart the medication chart seems to have multiplied. Insulins, intravenous fluids and medications for long-stay patients can result in several medication charts.

The premise of all these forms, charts, protocols, notices, guidelines, instructions and flow-sheets is to improve “quality, safety and outcomes for the patient journey”.

However, when the folder becomes as bulky and cumbersome as it now is, my concern is that the patient journey becomes one of clinicians poring over papers rather than (heaven forbid!) the patient being spoken to or examined.

So confusing have the bedside charts become, the potential for mistakes and missing critical data is greater than ever. Add to this the “team” approach that in reality is very piecemeal in many hospitals — with different people prescribing different things at different times — it is little wonder so many mistakes are made in hospital settings.

For example, it’s not uncommon to have a patient in hospital with rheumatoid arthritis, heart failure and diabetes – as well as recovering from surgery. And it would not be considered unusual for such a patient to develop an infection and chest pain.

If you do come across a patient like this on your ward rounds my advice is to discharge the rest of your patients, as you’ll need all day to read this one patient’s bedside chart.

And perhaps you should call the burly security guard to hold the bloody thing for you!
 

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.