Health

Summary

Ms C complained about the nursing and medical care received by her brother (Mr A) over two admissions to Belford Hospital. Mr A's first admission was due to severe abdominal pain and vomiting. He was treated and discharged the same evening. Mr A's second admission was two days later after he was found disorientated in his home. He was assessed and a request was made for an out-of-hours (OOH) scan of his brain. This was refused and the scan was not carried out until the following morning. The scan showed bleeding on Mr A's brain and he was transferred to another hospital for surgery. Ms C also complained that the board had failed to respond appropriately to their complaint.

Ms C said Mr A was not properly assessed during his first admission. She said he should not have been discharged after receiving morphine and said Mr A had no memory of when he was discharged or how he got home.

Ms C said Mr A had been left in soiled clothing during his second admission, which had been distressing for his family. She said nursing staff had failed to provide personal care until the family had insisted. Ms C also said the failure to perform a brain scan sooner had put Mr A's life in danger. Ms C said the family had repeatedly told medical staff they believed Mr A was displaying symptoms of a brain injury.

We took independent medical advice from a consultant physician. The adviser said that Mr A's care and treatment during the first admission was adequate. However, the adviser said that Mr A was displaying sufficient symptoms of brain injury to justify OOH scanning earlier than he received the scan. This was unreasonable and should have been addressed in the board's complaint investigation.

We also took independent advice from a nursing adviser. They noted the records showed that staff had attempted to provide personal care to Mr A during his second admission, but that he had not been compliant.

We found the nursing care provided to Mr A was of a reasonable standard. However, we found that the medical care was not, since he should have had a brain scan sooner, although this delay did not impact on the outcome of his treatment. We also found the board's complaint response contained inaccuracies and Ms C's complaint was not investigated to a reasonable standard. We made recommendations to address the failings we identified in these different areas.

Recommendations

We recommended that the board:

• review their local protocol on the management of patients displaying abnormal brain function to ensure it is in accordance with Scottish Intercollegiate Guidance Network (SIGN) guidelines 107 and 108 which relate to the management of headache in adults and patients with strokes;
• draw the attention of the radiologist in this case to the requirement of SIGN guideline 108 for imaging for patients with suspected stroke;
• ensure the reasons for any delay in a complaint response are fully explained at the appropriate time;
• review this complaint to establish why the final response contained inaccuracies; and
• apologise in writing for the failings identified in this investigation.

Summary

Mr C, who works for an advice agency, complained to us on behalf of Mr A that the board had failed to diagnose what was causing his hypoglycaemia (low level of glucose in his blood). Mr A had been diagnosed with type 1 diabetes as a child. In his early twenties, he started to have hypoglycaemic episodes and was told to reduce his doses of insulin. He continued to have these episodes and was admitted to hospital on a number of occasions to be monitored.

We took independent advice on the complaint from a medical adviser, who is a consultant in medicine and endocrinology. We found that Mr A's recurrent hypoglycaemia had been promptly and appropriately investigated by the board and they had reasonably tried to manage this by giving him an insulin pump. We did not uphold this aspect of the complaint.

Mr C also complained that nursing staff had failed to provide reasonable treatment to Mr A when he was in Broadford Hospital. However, we found that the nursing staff had acted appropriately and we did not uphold this complaint.

Finally, Mr C complained about the board's handling of Mr A's complaint. We found that there had been an unreasonable delay by the board in responding to the complaint, although they had apologised for this delay in their response to Mr A. The board had also failed to respond to Mr A's complaint about nursing staff in Broadford Hospital. In view of these failings, we upheld this complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mr A for failing to respond to all of the issues he had raised in his complaint; and
• make the staff involved in the handling of Mr A's complaint aware of our decision.

Summary

Ms C, who is an advice worker, complained on behalf of Mrs A about the care and treatment she received at Raigmore Hospital. In particular, Mrs A said that the hospital failed to communicate adequately with her and her family during her admission. She also said that the hospital failed to provide an appropriate standard of nursing care or appropriate medical treatment.

We took independent advice from a nursing adviser and a medical adviser who is a hospital consultant. We found that the level of communication with Mrs A and her family was reasonable, as was the level of communication between medical staff. However, our investigation showed that the board failed to provide Mrs A with an appropriate standard of nursing care. We were mindful that the board had accepted there were failures in relation to nursing care and had taken action to address these matters.

We found that the medical care and treatment Mrs A received in the hospital was reasonable.

Recommendations

We recommended that the board:

• consider the nursing adviser's comments about the overall standard of record-keeping and provide details about when the improvements to nursing documentation are to be implemented and evaluated;
• provide an action plan to address the failures in relation to nursing assessments and pain management identified in this case;
• consider the medical adviser's suggestion about the development of a care plan for Mrs A and report back to us on any action taken; and
• remind relevant staff of the need to label each page within medical records with the correct patient identification details.

Summary

Mr and Mrs C complained about the care their daughter (Miss A) received at Stobhill Hospital for treatment of anorexia nervosa. They were concerned about the care plan that was in place and that the board had acted inappropriately when attempting to remove Mrs C as Miss A's named person under the Mental Health (Care and Treatment) (Scotland) Act 2003. A person being treated under the 2003 Act can choose someone to help protect their interests.

We took independent advice from one of our advisers who is a consultant psychiatrist, and found that the care and treatment was reasonable overall. We considered that staff had appropriately managed situations which could potentially have had a negative effect on Miss A's treatment. We concluded that there was evidence to support that the board were acting in accordance with national guidance and in Miss A's best interests to assist her recovery when attempting to remove Mrs C as named person.

Summary

Ms C complained about the treatment which an out-of-hours GP provided to her late sister (Ms A). Ms A had acute myeloid leukaemia (cancer of the white blood cells that accumulate in the bone marrow) and was receiving chemotherapy. Ms A attended the out-of-hours GP with pain in her back passage. She was diagnosed with haemorrhoids (swollen blood vessels in or around the anus and rectum) and sent home. Ms A continued to be in pain and contacted the out-of-hours service the following day and she was admitted to hospital where she was diagnosed with having necrotising fasciitis (a severe skin infection). As a result, a large area of her buttock was removed and a stoma bag was fitted. Ms C felt that Ms A should have been admitted to hospital on the first occasion.

We took independent advice from an adviser in general practice and concluded that the GP who initially saw Ms A carried out an appropriate examination and that the diagnosis of haemorrhoids was reasonable. Ms A's GP had made a reasonable diagnosis based on the presenting symptoms and in view of Ms A's previous medical history. Ms A's condition had deteriorated quickly in between attending the GP and being admitted to hospital. We did not uphold Ms C's complaint.

Summary

Miss C complained to us about the care and treatment she received when she attended A&E at the Royal Alexandra Hospital. Miss C had previously been diagnosed with a suspected inguinal hernia (an opening in the wall of the lower abdomen near the groin) and had been referred for an out-patient ultrasound scan and an appointment to see a general surgeon to discuss the treatment options. Whilst awaiting this appointment, Miss C attended A&E with increasing pain from the area. She was examined by doctors who did not identify any palpable (able to be touched or felt) lump and found that she was clinically well. She was discharged with painkillers. Miss C subsequently went on holiday, but had to cut her holiday short due to worsening symptoms. She was admitted to hospital when she returned from holiday. It was subsequently identified that she had a groin abscess, which had to be drained. Miss C considered that the doctors in A&E had not carried out a reasonable assessment and had failed to identify the abscess.

We took independent advice from a consultant in emergency medicine. We found that it was not likely that the abscess was present when Miss C had attended A&E. The assessment carried out by doctors in A&E had been reasonable. It had also been reasonable for staff not to carry out blood tests or an ultrasound scan and to discharge Miss C with pain relief and to await the ultrasound scan. Although we did not uphold the complaint, we did identify some areas for improvement and we made a recommendation to the board in relation to this.

Recommendations

We recommended that the board:

• remind the staff involved in Miss C's care that they should monitor and record the pain experienced by a patient and also the effectiveness of treatments given to relieve the pain; full documentation of assessments and second opinions should be made to provide contemporaneous notes for each attendance; and they should record what advice is given to patients when they are discharged, particularly in relation to follow-up arrangements, what to do if things get worse and also advice about travel, driving or work.

Summary

Mrs C complained about the clinical treatment and nursing care that her late mother (Mrs A) received at the Glasgow Royal Infirmary. Mrs A was admitted after becoming unwell at home and it was suspected that she was suffering from gallstones blocking the bile duct. Mrs A had a number of existing conditions and had been prescribed clopidogrel (a drug that reduces blood clotting) for one of these conditions.

As Mrs A was on clopidogrel, which increases the risk of serious bleeding during invasive tests, it was decided that a scan would be carried out to investigate. This confirmed that she had a blockage in the bile duct and it was agreed that an endoscope (a thin flexible tube) procedure would be arranged to investigate further and clear the blockage. Mrs A's clopidogrel had been stopped the previous day due to other test results and so arrangements were made for the endoscope procedure to take place in six days' time. Mrs A's condition deteriorated a few days later and she developed sepsis (blood poisoning) before the procedure could be carried out. She was transferred to the high dependency unit but passed away.

After taking independent advice from an adviser who is a consultant surgeon, we did not uphold Mrs C's complaint about clinical treatment. The adviser considered that appropriate investigations had been carried out and that while having the endoscope procedure earlier might have avoided sepsis developing, it was reasonable practice to have waited until the clopidogrel had been stopped for a period of seven days before undertaking the procedure. The adviser also considered that the drug had been stopped at a reasonable point in Mrs A's admission.

After taking independent advice from a nursing adviser, we did not uphold Mrs C's complaint about nursing as no failings in care were identified.

Summary

Mrs C complained on behalf of her late husband (Mr A) about care he received from his GP practice. Mr A attended the practice having been diagnosed with oedema (where fluid collects in the legs and abdomen). He had been prescribed medication to combat the oedema. Mr A was referred to his GP to investigate the cause of the oedema and the GP took blood tests, which were normal. The GP also noted that, apart from the oedema, there were no signs of heart failure. As Mr A was obese, and therefore at greater risk of heart problems, the GP referred him for an echocardiogram (a heart scan that uses sound waves to create images) to investigate any potential heart problems. Mr A passed away before he was seen for a heart scan. The cause of death was an enlarged heart.

We took independent advice from a medical adviser. The adviser was satisfied that the practice had made appropriate investigations into Mr A's symptoms and made an appropriate referral. For this reason, we did not uphold the complaint.

Summary

Ms C, who works for an advice agency, complained on behalf of Mrs A. Mrs A said that her husband (Mr A) had been provided with inadequate care during an admission to Glasgow Royal Infirmary. Mrs A believed that Mr A had not been provided with appropriate antibiotics and that there were delays in providing him with medication. Mr A had undergone surgery, but had subsequently deteriorated. He had suffered a heart attack at the start of visiting hours and Mrs A had to wait in a day room. Mr A had subsequently died before Mrs A was able to see him.

We took independent medical advice on Mr A's care and treatment. The adviser said Mr A had suffered from a serious heart attack, as well as kidney problems. Although there were instances when he did not receive medication promptly, these did not impact on his prognosis, or the outcome of his treatment. Mr A had suffered two major heart attacks in succession on the day he died. All reasonable resuscitation techniques had been tried, and it was reasonable that Mrs A was not allowed in to see Mr A whilst resuscitation was being attempted.

We found that Mr A had received reasonable clinical care and treatment and the delays in administering medicine had been investigated and addressed appropriately by the board. We therefore did not uphold the complaint.

Summary

Mrs C's mother (Mrs A) was admitted to the Glasgow Royal Infirmary with a chest infection. After initial improvement and transfer to another ward her condition deteriorated. She suffered a cardiac arrest and died while awaiting admittance to the intensive care unit. Mrs C raised a number of concerns about her mother's care and treatment. These included that the board's medical and nursing staff failed to review, monitor and treat her mother appropriately and that the board did not make reasonable efforts to communicate her mother's condition to her family.

We obtained independent advice on the complaint from a consultant physician and a nurse. The consultant adviser explained that Mrs A was reviewed by medical staff on several occasions each day, including specialist haematology input. They said Mrs A's treatment included antibiotics which were reviewed and altered according to her evolving clinical problems and results from the laboratory. The consultant adviser said all of this was reasonable.

The nursing adviser said that observations on Mrs A were carried out frequently and in accordance with the board's policy. They said that when Mrs A's condition deteriorated, the appropriate action was taken with the nursing staff reporting this to a senior clinician.

From Mrs A's arrival on the hospital ward to the point when her health deteriorated, the advisers were not critical of the level of communication with the family. However, the advisers considered that after Mrs C and her family were called to attend hospital following the deterioration in Mrs A's health, the board did not make reasonable efforts to communicate with Mrs C and her family about Mrs A's condition. We upheld this aspect of Mrs C's complaint and made a recommendation to the board.

Recommendations

We recommended that the board:

• provide us with evidence of the steps that have been taken to ensure that in future proactive communication takes place with a patient's family when a patient deteriorates.