Monday, April 13, 2009

An Idiopathic Intravenous Infusion!

The hospital set up a system to monitor Hari's platelet levels and it generally worked well.

Their plan was that on the way to physio sessions we would go to A&E and Hari would have blood taken. By the time the physio session was over the results would be available. If Hari's platelet count was above a certain level then we could just go home, if the platelets were below that level we would have to wait so that Hari could be seen by a doctor. On the occasions when the count was low Hari was usually admitted

Treatment was in the form of an immunoglobulin administered intravenously. It would be administered daily for three days. Hari would have 60 mls of the immunoglobulin on each of the three days.

The product came in 100 ml bottles and any left over had to be kept in a fridge and used within about six hours. Obviously the 'spare' 40mls could not be used for the next day's dose so it had to be discarded.

Or that was the theory!

On one occasion Hari's third dose was due but hadn't been administered before I had to leave the hospital to collect my eldest daughter from school. The nursing staff assured me that the dose would be administered that evening.

When I got to the hospital in the morning it was explained that they had only had 40mls of the immunoglobulin available the previous evening so Hari still needed another 20mls.

The maths wasn't difficult!

The immunoglobulin came in 100 mls bottles - so if they had 40mls available they must have had 60mls available.

Then they admitted that they had used what they said was the 40ml excess from the previous day.

They had no idea at all if their could be any adverse reactions from using the leftovers beyond the stated time limit of six hours - but they had given it to her anyway!

Then I realised the other problem with this action.

On day one the leftover immunoglobulin had been left on the windowsill of the treatment room in full sun - it was not put into the fridge.
On day two the leftover immunoglobulin from day one was still on the windowsill and that day's leftover was thrown into the bin.

So neither of the previous two days' leftover immunoglobulin had even been correctly stored!

They insisted that they had used the leftover from day two - so that would be the one that had been thrown into the bin!!!!!!!! Had they really fished it out of a bin full of used and contaminated dressings etc. before administering it to Hari intravenously? Well they were obviously never going to admit THAT but they insisted that they had used the leftovers from day two (having checked the date on the bottle) and I had witnessed that bottle being thrown into the bin!

Somebody vaguely looked in a book to check for possible adverse reactions but couldn't find anything. They were not exactly keen to explore this avenue and I had to get extremely annoyed before they would take any notice at all - finally a more senior doctor was called in. (This being a Saturday you are supposed to be dead before this happens!!!!!!!!!)

His main concern seemed to be that I should take Hari home immediately and bring her back for the final dose on the Monday.

Did they really think I was stupid?

THEY had put Hari at risk, THEY had no idea of what any possible adverse reactions might be - and THEY wanted her out of the hospital immediately so that if anything did happen they could claim it must be related to events outside the hospital.

If an adverse reaction was to occur I wanted it to happen in the hospital where it could be dealt with immediately - not at home which was over 20 miles from the hospital.

I think they were a little surprised when I refused to take her home!

Fortunately for Hari she didn't experience any noticeable adverse reaction - but that appeared to be more luck than judgement!

On the Monday one of the staff nurses told me she had put in a formal report about this incident - she also told me not to expect them to actually do anything about it - because THEY never do!

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