By Allan Vann, Huffington Post, February 29, 2016
My wife Clare has Alzheimer’s disease and recently spent three weeks in a psychiatric hospital, a separate building among many on a huge hospital campus. Clare was admitted due to severe anxiety issues, and I was extremely impressed with the quality of medical care she received from her psychiatrist and nurses on a daily basis. However, I would recommend several changes be made in medical protocols, activity scheduling and in the roles of hospital aides to enhance the lives of Alzheimer’s patients in psychiatric hospitals.
Medical protocol decisions
Clare had a near syncope (fainting) episode during her second day in the hospital. (She never actually passed out, which is why doctors termed it a “near” syncope event.) I cannot fault the hospital protocol that required additional testing to rule out other issues... especially for a newly admitted patient with a history of heart disease and seizures. It is where and how this testing took place that raised concerns.
The two nurses on duty in Clare’s unit were not allowed to draw blood for analysis nor was an onsite doctor allowed to order an IV drip, perform an EKG, or take a simple chest x-ray. Clare had to be taken by ambulance to the Emergency Department (ED) located in a separate building on campus. Waiting for an ambulance and physically moving Clare into the ED took more than half an hour, followed by almost six hours spent on a gurney in the ED without being allowed to have any food or medication. Needless to say, all of this served to greatly increase Clare’s anxiety.
To avoid having to transport psychiatric patients unnecessarily to an anxiety- producing environment such as an ED, psychiatric unit nurses should be allowed to draw blood and administer IV units of saline. Similarly, a portable EKG machine and portable x-ray machine should either be in a psychiatric hospital, or should be brought to the psychiatric hospital, so a doctor can do those procedures onsite. Psychiatric hospital patients should always receive medical care onsite as a first option. Only if more sophisticated testing or equipment is needed should the patient have to undergo the traumatic experience of being taken by ambulance to an ED in another building, and then forced to lie on a gurney for many hours until all testing is completed and analyzed. A visit to the ED should be the last option, not the first option, especially for a patient with Alzheimer’s disease who is being treated for severe anxiety ... and a patient who never even lost consciousness.
Clare was so anxious in the ED that she ripped out her blood work needle and her IV drip needle. She also fought getting back into a wheelchair for the trip back to the psychiatric hospital, repeatedly banging (and injuring) her toes on the footplates of the wheelchair. The following day, when nurses discovered that her big toe was black and blue, once again Clare was transported by ambulance to the ED for x-rays of her toe.
It is more in the patient’s interest ... especially someone with Alzheimer’s already being treated for anxiety ... if a portable x-ray machine were to be brought to the patient instead of transporting the patient by ambulance to the ED.
Activity Scheduling
There were only two activities scheduled for patients each day in the psychiatric hospital, each lasting less than thirty minutes. Recreation therapists led brief music or art activities each morning, however these activities were held during the same one hour that was set aside for visitors. Clare chose to spend her full hour with me each morning rather than participate in the lone morning activity. At least some activities should be scheduled for patients before or after visiting hours to avoid such conflicts.
Clare spent almost all of her waking time with virtually no sensory stimulation, spending countless hours each day with nothing to do other than talk with other patients (which she cannot do), sit in a chair and nap, watch TV, or stare across the room. For patients with Alzheimer’s who are being treated for severe anxiety, this is not a very supportive environment.
Aides could easily lead morning and afternoon art and music activities for patients who would like to participate. It doesn’t take much prior knowledge or skill to provide paper and crayons or markers so patients can draw, to lead patients in a sing-along, or simply provide music for patients to listen to while they are seated. More active involvement in activities would make time pass much more enjoyably for Alzheimer’s patients.
Role of the hospital aides
Most of the aides were excellent most of the time. They sat next to patients and shadowed them whenever they got up and moved about to be sure they didn’t fall or hurt themselves or others. They also accompanied patients to restrooms, which were kept locked at all times, and assisted patients with toileting. However, during Clare’s three weeks of hospitalization I never once observed even one aide engaging a resident in conversation. If aides engaged residents in conversation during the day, at least some patients might be a lot less bored during all of that ‘down’ time.
What needs to be done
A study on how hospitals deal with dementia patients, “Dementia-Friendly Hospitals: Care Not Crisis,” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955811/ supported in part by a grant from the National Institutes of Health, noted that “the greatest unmet need was in-service training to increase the staff’s understanding of dementia and strategies to improve the hospital environment for the patient with dementia.” The study found that staff themselves recognized that “they needed to improve their communication skills” with dementia patients.
As baby boomers age, psychiatric hospitals will see more and more people with Alzheimer’s and other forms of dementia. There are also bound to be more Alzheimer’s patients in hospital Emergency Departments. Hospital administrators need to link up with organizations such as the Alzheimer’s Foundation of America or the Alzheimer’s Association and start implementing productive in-service training for their staff.