Whenever people are discharged from the hospital after having had a flare or "exacerbation" of heart failure, they are asked to weigh themselves daily. When they go to rehab or nursing care facilities, the staff are asked to weigh the person daily. Unfortunately, a lot of the time, this doesn't get done, which as a doctor, I find completely mysterious. I was frustrated by this as a resident in training, and I am still frustrated by it today. Again today, I visited a woman out of the hospital for 3 weeks, who has atrial fibrillation (which makes the heart beat irregularly), who is being treated for congestive heart failure, and this one very simple way of tracking how things are going was simply not done during this entire time by the staff in the residential care facility where she is staying temporarily. despite being clearly written on her discharge instructions. Her ankles were getting more swollen, which the staff though was just due to her spending more time upright in a chair. The only way of knowing would be to have those daily weights....
One doesn't need a medical scale or to be 100% precise, but one does need an idea of whether the weight is trending up rapidly or not showing that fluid is accumulating....
Please, caregivers for people with heart failure...do this simple thing!!
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2 comments:
Of course heart failure patients need to be weighed and it would really help you to provide better care if you had access to that data. But there might be a slew of reasons why it does not get done. Maybe the nurse is busy, the health care aid who is supposed to weight the heart failure patients does not realize the importance of the task, and there are many other items of busy work for the aides, nurses, and other health care workers to do such that time gets short, people forget, and not everything gets done. You might understand better if you spent a day or a week in the life of the kind of person who is supposed to weigh the heart failure patients. And the heart failure patient might not be easy to weigh for a number of reasons: obesity, confusion, non-compliance, combativeness to name a few. None of these justifications mean that the task should not get done. Maybe it would help for physicians to educate nurses and aides about the importance of weighing heart failure patients. Also, a root cause analysis could be employed at the facility to find out why that physician order was not done.
Thanks for those thoughtful comments, Dulcy. Certainly the aides and nurses have a lot of work. I am well aware that the problem is not always with the person whose "job" it was...often the facilities don't have the systems set up correctly to make it easy to get it done, or overload the staff, as you point out. For example, after I wrote my post I discovered that the facility I was visiting didn't even have a scale (not ANY type of scale, even a simple bathroom scale!) in the building this patient was in!!! (I cannot put enough exclamation points after this...for goodness sakes, this is a certified residential care facility accepting people with heart failure...)
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