Decision Report 201701697

Summary

Mr C complained about the care and treatment his late wife (Mrs A) received from Dumfries and Galloway Royal Infirmary in relation to the decision and communication about de-activating her implantable cardioverter defibrillator (ICD - a device designed to treat abnormal heart rhythms). Mr C also raised concerns that no discussions took place with Mrs A about a 'do not attempt cardiopulmonary resuscitation' (DNACPR - a decision taken that means a healthcare professional is not required to resuscitate the patient if their heart or breathing stops) order being put in place until after the decision had been taken by medical staff. In addition, he was dissatisfied that staff had not clearly communicated that Mrs A's condition had worsened to the point that she was in the end of life stage.

We took independent advice from a consultant cardiologist. We found that there was sufficient evidence to show that discussions had taken place about the DNACPR order on two separate occasions. We also considered that it was appropriate clinical practice to de-activate Mrs C's ICD given that her condition had significantly deteriorated and there were no other treatment options possible. Whilst we did not uphold these aspects of Mr C's complaint, we welcomed that the board have taken steps to improve how conversations about de-activating ICDs are carried out.

In terms of Mr C's concerns about communication regarding end of life, we found that there was evidence to demonstrate that conversations took place about the reasons why there were no treatment options possible, and that palliative (end of life) care was Mrs A's only option. Whilst palliative care had been started, we found that there was no indication at the time of discharge from hospital that Mrs A would die as soon as she did afterwards. We, therefore, did not uphold this part of the complaint.