Alcohol in hospital?

[Kiltie]

To an extent, this follows on from a previous thread but new question so I chose to make a new topic.

My father (87 in May) has a compression fracture in one vertebrae element. He is in a rehabilitation ward in a local hospital (NHS).

He is written up for morphine as follows.

• MST 5mg twice a day.
• Oramorph 10mg / 5 ml as required (up to 240mg in 24hrs).

He is on a number of other medicines, is diabetic, has a history of heart trouble and is permanently on oxygen (COPD).

Since being in hospital (admitted 27/12/13), he's had periods where he's been very confused (raving and hallucinating at times).

The other day, there was a discussion between him and my mother where he asked for some whisky to be brought in. He said he'd checked and it was ok. I told my mum to ignore this as it was obviously made up or part of a dream.

I just couldn't believe that a hospital would allow a patient taking morphine to have alcohol.

Wind the clock forward to this evening and I find that whisky has indeed been brought in for him. I was adamant that this couldn't be right and I was astonished when I looked at his drugs schedule.



Apart from reading that morphine and alcohol seems to be universally advised against; I have three big concerns.

• Although it's written up, the fact that it's supplied by a family member means that it's uncontrolled (it could be anything of any strength in the bottle).
• The bottle (it's a ½ bottle actually) is sitting on top of his bedside unit and not in the locked cabinet on the wall. The amount he gets can't then be controlled.
• I can see that a small volume of alcohol might be deemed ok with a regular dosage (e.g. the MST) but there doesn't seem to be a link to how much oramorph he might have had in the preceding few hours.

Now I accept the point made by Prof Prolapse in the other thread that I should really be raising concerns with the medical staff before seeking advice from strangers on PH.

Nevertheless, I'd be interested if anyone has any experience - perhaps with their own elderly relatives.

Edited to replace image

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Edited by Kiltie on Sunday 23 February 23:47

[nagsheadwarrior]

I worked in a very plush and ridiculously old fashioned private hospital in midhurst in the early 00s, the meals came with a wine list!

If I recall right at least on oncology the patients had their choice of spirits too.

[BlackLabel]

I spent a lot of time in rehab a couple of years ago (spinal injury) and out of the 30 odd patients on my ward one would smoke several spliffs a day and 2 or 3 were regular weekend drinkers. As long as they didn't get completely drunk then the staff would turn a blind eye. And yes all of these guys were on morphine and a cocktail of other pain killers. If they did get drunk then they'd be issued with 2 warnings and a third time they'd be asked to leave.

You would have to drink outdoors though (or discretely in the tv room). The nurses told me that they used to allow open drinking on a fri/sat night but this stopped 6 or 7 years ago as people used to go ott with it.

[dave_s13]

That posted image breaks all sorts of information governance rules btw.

I wouldn't begrudge an 87yr old poorly chap a tot of whiskey. Speak to the ward sister and see what they say.

[Kiltie]

dave_s13 said:

That posted image breaks all sorts of information governance rules btw.

I'm not sure what rules might have been broken but thanks - I've obscured names and signatures.

dave_s13 said:

I wouldn't begrudge an 87yr old poorly chap a tot of whiskey.

Neither would I but prior to going in to hospital and being given morphine, he was reasonably clear thinking and lucid. Much of the time since, when awake he's in a very confused state and sometimes distressed. I can't see alcohol having any positive effect on that.

dave_s13 said:

Speak to the ward sister and see what they say.

Yes indeed, this is the obvious thing to do. I'm just worried about causing a fuss which results in the whisky being removed as a precaution and then there being resentment from my father and other family members for interfering.

Edited by Kiltie on Monday 24th February 00:00

[JumboBeef]

Kiltie said:

He is on a number of other medicines, is diabetic, has a history of heart trouble and is permanently on oxygen (COPD).

Since being in hospital (admitted 27/12/13), he's had periods where he's been very confused (raving and hallucinating at times).

OP.

The written reply on the internet can sometimes/often come across in a completely different way than the writer intended. I hope you read this in the way I am trying to write it, ie: as a compassionate and understanding person who sees very ill elderly people all the time at work.

Based and what you have said above, and I apologise in advance if I have missed something relevant you have said somewhere else, I would say:

It would seem to me that your father is now on palliative care. In that case, then he should be able to have whatever he wants (within reason) to ease his days. I would let him have his nip (or two) whenever he wants it and let him enjoy it. Does he have a DNACRP in place?

I wish your father peace and rest, and good luck to you and your family.

[Kiltie]

JumboBeef said:

Kiltie said:

He is on a number of other medicines, is diabetic, has a history of heart trouble and is permanently on oxygen (COPD).

Since being in hospital (admitted 27/12/13), he's had periods where he's been very confused (raving and hallucinating at times).

OP.

The written reply on the internet can sometimes/often come across in a completely different way than the writer intended. I hope you read this in the way I am trying to write it, ie: as a compassionate and understanding person who sees very ill elderly people all the time at work.

Based and what you have said above, and I apologise in advance if I have missed something relevant you have said somewhere else, I would say:

It would seem to me that your father is now on palliative care. In that case, then he should be able to have whatever he wants (within reason) to ease his days. I would let him have his nip (or two) whenever he wants it and let him enjoy it. Does he have a DNACRP in place?

I wish your father peace and rest, and good luck to you and your family.

Thanks JB.

Kiltie said:

My father (87 in May) has a compression fracture in one vertebrae element. He is in a rehabilitation ward in a local hospital (NHS).

Not palliative. As far as I'm being told, everyone is working towards getting him to a level of independence whereby he can return home. Monday to Friday, he's being taken to the physiotherapy gym next door to the ward. They're currently assessing how he can sit / stand / walk etc with / without back brace. He's also seeing OTs, dieticians etc.

I agree, if this was palliative, he should be allowed whatever he wants (within reason).

Thanks again - particularly for the considered way you presented your reply.

[z4chris99]

My grandfather used to have a bit of whisky every day, he had parkinsons and dementia and was very ill and on all sorts of painkillers and pills.

my advice is that hes 87, let him do what he wants and enjoy your time together.

[JumboBeef]

Kiltie said:

Not palliative. As far as I'm being told, everyone is working towards getting him to a level of independence whereby he can return home. Monday to Friday, he's being taken to the physiotherapy gym next door to the ward. They're currently assessing how he can sit / stand / walk etc with / without back brace. He's also seeing OTs, dieticians etc.

I agree, if this was palliative, he should be allowed whatever he wants (within reason).

Thanks again - particularly for the considered way you presented your reply.

I'm glad you read it as I tried to write it

Is there a DNACPR in place....? Again, based on what you say I would say there should be. It would be in his best interest.

[MacGee]

Data and info governance.....no name or identifiers...so no probs!
good luck and let him enjoy his life. My dad died in October and my family got home for his last few weeks. You'd want it for you!

[Kiltie]

Thanks all.

Just to be clear, he isn't terminal - just in pain as a result of the compression fracture.

He's been pretty much immobile for three or so months now so needs rehab in the form of physio etc to get him fit enough to return home.

If he puts in the effort and listens to the advice of the medical staff, I'd expect him to be able to go home and lead a relatively normal life (going to shops / out for dinner occasionally etc.)

We're hence a wee way away from DNACPR and the likes.

My original concern was his reaction to morphine (either sleeping or confused). Before hospital, he was compos mentis.

In this particular post, I'm raising a further concern as I can't see alcohol doing anything positive for his current set of circumstances. It's not going to help him think more clearly or stay awake or become enthusiastic about his physio.

[Engineer1]

Raise it with the hospital staff you know him they don't so may not have any idea how far from himself he is it could be side effects of medication it could be that the dose they are giving is having a funny effect on him, but unless the staff know they can't react.

[Kiltie]

Engineer1 said:

Raise it with the hospital staff you know him they don't so may not have any idea how far from himself he is it could be side effects of medication it could be that the dose they are giving is having a funny effect on him, but unless the staff know they can't react.

Pretty much word for word what my wife suggested last night. Thanks.

It's not quite so clear cut though. He can be speaking to my mum and I and seeing cats and faces in the walls and asking where he is; as soon as a nurse (or anyone external to the family for that matter) addresses him, POW he's back in the room and speaking as if there's nothing wrong.

I can see a situation where the nursing or medical staff might think I'm exaggerating.

Edited by Kiltie on Monday 24th February 13:14

[JumboBeef]

Kiltie said:

We're hence a wee way away from DNACPR and the likes.

Hi Kiltie,

I've typed, and retyped this reply, and so I hope I get this across to you in the right way: he is 87 with chronic illnesses: when do you think you should consider a DNACPR?

I'm sorry to say when your dad suffers a cardiac arrest (not if, but when: we all die) then full resuscitation is not going to bring him back (taking his age and medical conditions into account).

I am a Paramedic and I have (and will be again) been in the unfortunate position of being called to elderly people with chronic medical conditions who have died, often peacefully. However, law dictates that if it happened in front of people and I get there within 20 minutes then I have to undertake full resuscitation. (Massive generational: lots of things to consider).

This means, instead of letting someone die peacefully, they are pulled onto the floor, have their ribs broken though CPR, have needles stuck in their arms (or needles drilled into their legs), have tubes put down their throat and drugs pumped into them. Then they might be subject to rapid transport to hospital where they might be put on a "thumper" (compressed air machine which continues CPR and yes it is as brutal as it sounds).

Then they will die, after suffering all that trauma, in hospital instead of in bed.

I'm not going to hijack this thread (more than I have already). But I do feel very strongly people accept that the elderly/ill are going to die, and to let them go, when their time comes, in peace.

If you want any more info, please PM me, or maybe we should start another thread.

I know this is difficult and I'm sorry if I have come over in the wrong way: I am honestly trying to help you now to avoid a very difficult and potentially nasty situation in the future.

[Kiltie]

OK, thanks, I get the message.

JumboBeef said:

... maybe we should start another thread.

Be my guest.

Edited by Kiltie on Monday 24th February 14:55

[MacGee]

So its a bit like Monty Python...bring out your dead......but I'm not dead yet!....you soon will be!..sketch!

[sawman]

It is (or al least was when I last saw an orderbook) possible to order whiskey/brandy etc from nhs supplies - specifically this is for patients who may be on palliative or long term care. I am told its usually quite decent stuff that arrives, thanks to the bulk buying power of the nhs.

[HughS47]

As an FY2 I prescribed a measure of sherry for a chap on a rehab ward. The bottle was kept in the locked drugs cabinet along with all his other meds. Provided the senior clinician is happy with the decision, we didn't have any rules against it being written up.

You might get some funny looks from the nurses if you tried it anywhere other than MFE or rehab wards though. I'd be worried about mixing it in with all the opiates, but at that dose, why not....

Edit - read some more of the thread:

Some interesting issues here. Certainly it isn't wrong for the alcohol to be prescribed, but if the onset of confusion is new and this is the only change to the drug charts, it needs to be reviewed on the ward round. Regarding confusion, in an 87yr old with COPD on morphine, it is sometimes difficult to know where to start.

Personally, I think that DNR discussions are very important to have with family and relatives. Luckily in paediatrics we often don't have to do this, until it is very clear of the outcome. The article in the Daily Mail regarding one reporters 'personal' experience of the LCP has gone a long way to set back peoples attitudes towards end-of-life care in the UK and has caused some of my friends no end of grief in their roles in medicine/surgery. We're very bad at discussing end-of-life decisions and interestingly, Belgiums new laws may still open a can of worms (Child euthanasia)....

Edited by HughS47 on Monday 24th February 23:03

[BlackVanDyke]

Alcohol with morphine isn't the absolute no-no it sounds like - I understand that they each enhance the effects of the other, so having them literally simultaneously or in large quantities is a really spectacularly bad idea, but that's all.

I was told I'm OK to drink in strict moderation on long-term slow release morphine - given my annual booze consumption in units is only scarcely into double figures, and I've been strictly cautioned not to drive if I've had any boozahol at all (I wouldn't anyway), it all seems pretty reasonable.

I'm tickled to see it on the chart though! I think it's actually a very sensible way of keeping track of what he's had.

[slipstream 1985]

maybe enjoying a whisky will have a benefit on his recovery.