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Decision Report 201306143

  • Case ref:
    201306143
  • Date:
    November 2015
  • Body:
    Ayrshire and Arran NHS Board
  • Sector:
    Health
  • Outcome:
    Some upheld, recommendations
  • Subject:
    clinical treatment / diagnosis

Summary

Mr C complained about the medical treatment and nursing care that his late wife (Mrs C) had received from the board at University Hospital Crosshouse and University Hospital Ayr. Mrs C as admitted to Crosshouse Hospital four times in seven months, as well as being seen at the accident and emergency department on another occasion. She was initially diagnosed with both chest and urinary tract infections. Later, delirium became a significant issue for Mrs C. She was transferred to University Hospital Ayr so that her urology (concerned with the urinary system) symptoms could be investigated. She was discharged when this was completed but was readmitted to Crosshouse Hospital a short time later.

In relation to the medical treatment that Mrs C received, we took independent advice from a consultant physician. We found that the majority of the care that Mrs A had received at Crosshouse Hospital was reasonable. However, the adviser noted some concerns about the way that Mrs C's delirium had been managed, as changes that had been made to her medication could potentially have affected this. The adviser also highlighted concerns about the level of discharge planning that had taken place. On balance, we found that there was enough evidence to uphold Mr C's complaint about the treatment that his wife received at Crosshouse Hospital. The advice stated that the treatment provided at Ayr Hospital was reasonable. There were some concerns about the level of discharge planning that had taken place but, on balance, we did not uphold this part of Mr C's complaint.

After taking independent advice from a nursing adviser, we did not uphold either of Mr C's complaints about the standard of nursing care provided at Crosshouse or Ayr hospitals. We found that the care Mrs C had received was reasonable.

Recommendations

We recommended that the board:

  • review how patients with delirium are managed in light of the adviser's comments;
  • ensure that effective discharge planning is taking place on the relevant ward at University Hospital Crosshouse;
  • ensure that effective discharge planning is taking place on the relevant ward at University Hospital Ayr;
  • apologise for the failings identified by this investigation.

Updated: March 13, 2018