Friday, February 6, 2009

Frustrating Day

The day was quiet and orderly in most ways except for an underlying issue that had me muttering dire retribution.
I have a lot of patients who are being fed by nasogastric tubes and they are on what is called the HEN program (Home Enteral Nutrition) funded by the Government to the Hospital that inserts the tube. A family of 4 mth old twins who are both on tube feeding (ex prems and vomiting etc as neonates) have come to my attention from local Maternal & Child Health Nurse, as one was coming in to RCH for an Op. The tubes were put in by the Maternity Neonatal Hospital, so they are the HEN provider. However they discharged the babies to another hospital (That has a Children's ward) nearer their home and they say they are not able to provide tubes tape etc (true) but expect the family to travel back to the Maternity Hosp who say they do not treat babies after neonatal period (12 weeks). Talk about Bureaucracy gone amok! Well after this admission the father saw that we used pumps for the feeding. Great little things the size of a school lunchbox that can jut be put in the cot, under the pram, etc. no need to hang the bottle for gravity, so make life and mobility much easier.

Family had never seen these. So while they were at RCH (not really coming back so not our patients) we had our nutrition Department liaise with the otter Hospital to be sure they were on the HEN program there.We were assured they were and they went home to get the pumps organised.

I had a call at 4pm to say that the nurse had been on the phone for hours to the Mat Hosp and the other one and they denied they were on their HEN program (both of them) and they can't get pumps! If we put them on ours we use up our allocation quicker, so it should be spread around.

What riles me is that the second twin has not been admitted or seen anywhere since discharge until seen by a paediatrician yesterday, so technically she's no-ones patient! How can the system treat people like this!! Shades of the US health system!! The family had a rough time during the pregnancy with yes/no about a fetal diagnosis, further yes she has/no she hasn't cardiac afterwards etc. They are young and struggling; dad has had to us all his leave to help mum, who needless to say has PND!!!

I did have a Feel-good call though, from a hospital Paediatrician who rang me a few weeks ago about coming back to work, for some locum shifts, but her 7mth old refuses to take a bottle. She rang to say that after slowly following my advice the baby will now drink the required amount from a sipper cup. It's a Tommee Tippee one that they are now going to take off the market!! So she bought two!

Also love this Ad for spray oil! "If chef's knew about this they would use it too."
Hard to see but it's a doll on the back ledge of the stove.
No-one appreciates the conditions mothers work under !!
Girding up for the weather tomorrow the most 'dangerous day for bush fire risk in Victoria for years, even more than Ash Wednesday though The Met says a cool change is expected to blow in with a south-easterly wind about 6.30pm.

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