"My recent hospital experience"

On the morning recently I woke having rigours and fevers. I noticed some facial cellulitis starting. I will add that I am a casual Registered Nurse.

I asked my partner to drive me to Roebourne Hospital. I was seen by Emergency Telehealth (ETS) who advised to start me on IV Vancomycin and IV Cefazolin and transfer me to Karratha as soon as possible. My BP was dropping, O2 was required as saturations would not come above 92%. The RN called the AHNM (After Hours Nurse Manager) to let them know I was being transferred over. Their response to those nurses I believe was, you are a hospital you can keep them there. Roebourne Hospital is 2 nurses only no doctors. I believe the RN's were appalled at their response and contacted ETS again. ETS Dr who I believe is also a Fellow of the Australasian College for Emergency Medicine (FACEM) responded by saying absolutely not, please transfer to Karratha ASAP.

By the time I reached Karratha Health Campus (KHC), I had started to shut down. I was kept in ED approx 10 hours until I had stabilised somewhat. I believe KHC does not have a High Dependency Unit (HDU) - just a general medical ward. Not long after I reached the ward I spiked another temp over 40 deg and my whole face and neck became swollen and I did not recognise myself. My obs became unstable again and was transferred back to ED for another CT scan with contrast. (2 CT scans now within hours of each one) I was transferred back to the ward in the morning after stabilising again.

By the next few days, I had started to feel slightly better so the Vancomycin was stopped. I had had 2 days of 1.5g Vanc and Cefazolin. The next day, I woke and had trouble breathing. The swelling was the worst it had been. By this stage, I had seen 3 different doctors. The 3rd Dr gave me 40mg IV Lasix and an IDC was inserted. I was taken to CT yet again and another chest x-ray (CXR) because I had such severe neck pain. I had a diuresis of approx 4.5 L. Vancomycin (Vanc) was recommenced at a higher dose of 2 g. I found out a few days later it was taking 2 days for a Vanc level to come back. I saw a different Dr nearly every day. I had continued to have temps over 38 deg every day. By that day, I had had 7 days of Vancomycin.

I believe the Deputy Director of Nursing (DDON) was so concerned they called the Senior Medical Officer (SMO) to intervene as I was just not improving. That day my Estimated glomerular filtration rate (eGFR) had dropped to 39. My partner and I were extremely worried and my CRP (c-reactive protein) had skyrocketed yet again. My partner spoke to the SMO. They had told us that the Vanc levels take 2 days to come back. My partner asked why had I not been flown to Perth if I had a sepsis which was not improving and Vanc levels to take 2 days to come back. The SMO agreed that it would be a good idea to RFDS (Royal Flying Doctors Service) me to Perth. By the next day, my eGFR had dropped to 31 and still no sign of RFDS.

The after-hours manager that day came into my room to tell us they did not know when RFDS would be coming and that it was completely out of their hands. My partner advised them they were really concerned as my kidney function was on a steep decline. The manager advised my partner that we could speak to EAP (Employee Assistance Program)! My partner was really upset as they said to them we do not need counselling we need action. The manager left the room and returned with the EAP number even though they had told them we did not need counselling. I was still at KHC by the following night. My eGFR was now 30 on that day - RFDS never arrived. By that afternoon I became extremely worried and stressed about my situation. I could not stop crying and I felt no one could help me. Out of desperation I called the Care Call number and explained my situation. The exec on call then called the after-hours Manager on that day who came to my room and asked if I had called the 1800 number for help. When I explained what had been happening they said that they had no idea as none of this had been handed over to them.

They then rang the clinical coordinator of RFDS who told them I was placed as a priority 3 and that no one had called them to tell them about my renal decline. RFDS suggested that I see another Dr and have my priority reassessed. I spoke to the Dr and also asked if they could please call the specialist in Perth to discuss my Vancomycin as I was really concerned about having yet another dose with my eGFR being 30. The specialist said to stop the Vancomycin immediately. RFDS arrived the next morning and my Vancomycin levels had gone to 65! Next eGFR was 24!

The reason I am writing this is in the hope that this will not happen to anyone else. I was somewhat lucky in that I was able to question my care along the way. What if this was someone who did not know any better?

If someone is so sick that they need Vancomycin in Karratha should they not be flown to Perth where Vanc level are able to be available within 6-12hrs? Not 2 days?

Why when they first received my drop in eGFR, was something not done about the Vancomycin?

In the 10 days I was in Karratha Health Campus I saw 8 different doctors. Whilst I am not complaining about any one particular Dr, I felt they all had differing opinions and clearly there was a lack of communication going on between the different Dr's and the nursing staff and communication to RFDS.

Staff skills

Team work

Treatment

Medication

Being listened to

Manager