Questions you may need to ask health-care staff

Helpful questions for the relatives, friends and carers of elderly or disabled people who have entered hospital as patients.

When elderly or disabled people enter hospital as patients, they may be in a very vulnerable state. Friends and relatives may be needed to act as their advocates, in an official or unofficial capacity. The health care staff, nurses, doctors and paramedical staff have different roles and responsibilities, but together they should ensure that the patient's needs are met. The patient's next of kin and close friends also have an important part to play. They should be consulted, when the healthcare team are formulating a care plan for the patient at the time of admission, and in relation to discharge planning.

The care plan requires your contribution so that the patient's needs may be met.
Never be hesitant to ask questions or make suggestions on behalf of your relative or friend.
You should feel free to ask questions of any team member as you see fit- but the nurse in charge should be the most appropriate.
It will help the team to know that someone is there to keep an eye on the situation.
Tell the team that you want to be kept informed about any changes in the care plan, from admission to discharge. (It is important when possible, to first get the patient's consent for this, and then confirm a clear agreement with family/friends as to who is the trusted person/next of kin.)
The staff will then identify your role and responsibility as friend or next of kin.

Some situations that may arise, and questions that may be useful.

Hydration and Feeding

Is the patient able to take anything by mouth?
Is it safe for the patient to eat, if so could I help with feeding?
Is there a 'Nil by mouth' notice by the bed? If so ask:
How long has the notice been there, and why is it there?
How long will the order notice last?
May I see the fluid intake chart? If there is no chart, you should raise the question of hydration by a drip into a vein or under the skin.

What are you doing about hydration?

If the answer is nothing, there is cause for concern, for no one can survive more than about a week without fluids of any sort. Dehydration can add to the patient's discomfort, cause thirst, confusion, severe agitation, kidney failure and ultimately death.

You may be told that the patient will not suffer from thirst, but this opinion is not universally accepted. It depends on the clinical situation.
If a person is not dehydrated, there may be reasons not to hydrate the patient if he or she is only likely to survive one or two days. Hydration by means of a drip under the skin is simple to insert in hospital or at home, as a prevention of thirst and delirium due to dehydration.

What are you doing about feeding?

It is not unusual to wait a while to see if a person regains the ability to swallow, if that is the problem, but while waiting, hydration should be provided. Most doctors advise that decisions about feeding should be taken sooner rather than later as malnourishment adds to the patient's problems.

If swallowing is a problem, the patient should be expertly assessed, and reassessed at least weekly.
Sometimes oral feeding can be maintained using specially thickened feeds. The advice of a dietician is helpful.
If no food can safely be given orally, feeding can be achieved via a tube, passed into the stomach either via the nose and throat, or directly into the stomach. The latter, called a PEG for short, requires a small procedure under local anaesthetic and sedation. The advantages and disadvantages of this procedure should be discussed with all concerned. It carries a very small risk.
If the doctors advise PEG feeding, accept their advice, because without food a patient will inevitably die. If they do not raise this matter, do so yourself.

Undue drowsiness

This can be due to a number of factors, but the first thing to check is whether the patient has been given a sedative, or medication such as morphine for any reason.

You are entitled to make enquiries about these matters. If sedation or other medication has been given ask "Why?" Keep on asking until you get an answer.

You may need to speak to one of the doctors, and if need be speak to the Consultant. If you are still not happy about the situation, ask for a second medical opinion.

Pain control

If the patient seems to be in discomfort or pain, report this to the nurses and ask them to assess the situation. There may be a simple explanation, such as a need for the toilet, or the need to be turned in the bed, or the need for a drink or some food. Abdominal pain is sometimes due to severe constipation, which can be overlooked and can make the elderly unwell and confused. A urinary infection can also cause discomfort and is a risk for those with catheters.

Sometimes patients are given morphine for reasons other than pain. It is also an effective medication to relieve coughing and shortness of breath.

If the patient has been prescribed pain medication, check the drugs listed and find out why they have been used. Some hospitals have been criticised for over using strong pain-killers, given via a syringe driver. This can be dangerous, but is valuable for patients who are terminally-ill whose pain cannot be controlled with simpler medication.

Further questions that may arise on care and symptom management.

How could the patient be made more comfortable?
What can be done about................................?
Would it be a good idea to try..........eg. pressure-relieving mattress, mouthcare?
Would it be a good idea to contact a Speech Therapist (in the event of swallowing/speech problems), Dietician, Consultant for Elderly Care, Physiotherapist, Occupational Therapist, Minister of Religion, Discharge planner,
In the event of a negative response, ask: "What grounds do you have for not contacting these people?"
How do you know that the patient is not experiencing hunger and thirst?

The ideal situation is that from the outset, there is good communication between the staff and the patient's relatives and friends.