This month we wanted to share with you all a good example of staff call for concern (Martha’s Rule). Pharmacy Technician at EDGH reported her concern regarding a gentleman whom on last review was mobilising round the ward making himself drinks etc. Upon reviewing him a few days later she found him in bed with decreased response, twitchy, wearing mittens with a DOLS in place and a security guard sitting outside his room. This chap was Polish and had no relatives or visitors only a daughter in contact by phone from Poland. He was initially admitted for Gastritis due to excess alcohol use. Notes revealed 2 falls over the weekend and 2 seizures. Patient had a CT Head which
was NAD, No further investigations undertaken. Reviewed by CCOT A to E assessment and repeat observations – showed NEWS 7 (Moderate risk of deterioration) Witnessed seizure with Right sided facial twitching. This was new so significant. Respiratory alkalosis on ABG with borderline K+, normal blood sugar.
Fluid balance chart commenced
Referred for MRI and neuro review (MRI showed changes in Lt temporoparietal lobe)
Lessons to be learnt
NEWS2 score on ward inaccurate as response
recorded as ALERT he was in fact at best confused (new confusion is a significant soft sign of deterioration) which would add 3 in one area which should trigger an alert for review. Clearly a significant deterioration over four day weekend with poor oral intake of fluid and food which were not reassessed or addressed. Patient is now improving, eating and drinking NEW2 score 0.
Right sided weakness (new)
Minimal oral intake for 4 days as too confused / unwell to get his own drinks.
Referred to Medical Registrar for urgent review.
Patient had I.V Thiamine, fluids and electrolytes prescribed.
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