Health

Summary
Mrs C complained about aspects of nursing care that her late father (Mr A) received in hospital in the two months before his death. The complaints included that Mr A was not provided with basic nursing care in relation to personal and oral hygiene or to ensure that he had adequate food and drink. Mrs C also complained about the time her father spent waiting in accident and emergency to be admitted to a ward and that the staff failed to listen when the family pointed out Mr A's inabilities to care for himself.

We took advice from one of our medical advisers, who is a senior nurse. We upheld two of Mrs C's three complaints. We found that the records showed that the level of nursing care provided was appropriate, but it was unacceptable that Mr A had to wait for more than seven hours to be admitted to hospital. Also, although Mr A was in hospital for about six weeks, there was little evidence of communication from the nursing staff to his family, even in the final days of Mr A's life. We, therefore, found that communication from the staff to the family was inadequate and that the record-keeping about this should have been better.

Recommendations
We recommended that the board:
• remind nursing staff of their responsibilities to ensure that record-keeping is maintained in accordance with the Nursing and Midwifery Council Code and Record Keeping guidelines; and
• apologise for the failure to admit Mr A to a ward within an acceptable timeframe.

Summary
Mr C complained about the treatment that his late mother (Mrs A) received in hospital. Mrs A had been admitted for a suspected stroke. A diagnosis of a TIA (transient ischaemic attack or 'mini-stroke') was made and Mrs A was discharged on a Friday to a facility staffed by mental health staff. Mr C and the mental health staff were concerned about Mrs A's condition and tried to arrange for Mrs A to be transferred back to the hospital but were told this could only happen after she had been assessed by a clinician. Mrs A was assessed on the Monday and was transferred back to the hospital, where tests revealed she had suffered a stroke. Mr C complained that Mrs A had not been fit for discharge on the Friday. The board conducted a significant event review which concluded that there was a breakdown in communications and staff at the facility did not follow recognised procedures and made several recommendations. Mr C also complained that the board failed to respond to his requests to meet with senior staff.

After taking advice from two of our advisers, a consultant physician and a senior nurse, we upheld Mr C's complaints. We found that poor record-keeping at the time of transfer contributed to a breakdown in communication between medical and nursing staff about Mrs A's condition, and that the board should have kept Mr C updated about plans for a meeting with staff.

Recommendations
We recommended that the board:
• share our findings with the staff involved and remind them of the importance of completing comprehensive discharge documentation to assist the receiving clinicians;
• apologise to Mr C for the way in which it dealt with his request to meet senior managers; and
• apologise to Mr C for the failings identified during this investigation.

Summary
Mr C was unhappy about the poor service he said he received from his medical practice, in particular the long wait for an appointment. He also said the practice had failed to advise him of the appointment procedure when he and his wife joined the practice and that their complaints procedure was not fit for purpose.

We found that the practice did operate an appropriate appointments procedure which complied with the guidance set out by Health Rights Information Scotland. We also found no evidence to suggest that the practice had failed to advise Mr C about the appointments procedure when he joined. Our investigation of Mr C's complaint showed that the practice's complaints procedure was accessible and fit for purpose.

Summary
Mrs C complained that medical staff delayed in diagnosing her son’s appendicitis. She said that this left him in severe pain and distress. We investigated the complaint and took specialist medical advice. Although it did take some time for appendicitis to be diagnosed, the advice we received was that that there were good reasons for this. Mrs C’s son’s clinical history and his signs and symptoms were not those of classical appendicitis. We found that it was appropriate for staff to consider other potential diagnoses. We also found that staff carried out appropriate investigations during that time, and that there was no delay in taking Mrs C's son to theatre after the results of a scan were reviewed.

Summary
Mrs C suffered urinary problems and underwent a cystoscopy (a medical procedure used to examine the inside of the bladder) in hospital. She subsequently developed symptoms similar to cystitis and was diagnosed to have contracted pseudomonas (a serious infection caused by bacteria). She complained that the board failed to follow appropriate decontamination procedures before carrying out the cystoscopy. While responding to our investigation enquiries for further information, the board found that there had in fact been a case of cross contamination. This had not been identified when Mrs C initially made her complaint to the board.

As a result of this new information, Mrs C decided to take legal action against the board, and subsequently withdrew her complaint with us. As a result, we made no finding on her complaint.

Summary
Mrs C was admitted to hospital for a gastroscopy (a procedure in which a thin, flexible tube is used to look inside the stomach) under general anaesthetic. She waited in the day room until she was allocated a bed. During this time a member of staff discussed confidential information with her while she was with other patients. Mrs C complained that the discussion should have taken place privately.

When Mrs C returned to the ward after the procedure, she went to the toilet to find bedpans piling up and their contents spilling on the floor of the only cubicle available. Nursing staff responded immediately when Mrs C raised the matter, but she was still unhappy and complained to us.

Mrs C later underwent a further test. She complained that staff told her that the consultant would give her the results of the test within a few days (or her GP would, within two weeks) and that the board failed to do either. The consultant wrote to Mrs C within five and a half weeks with the results.

We found that the board should not have discussed personal medical information with Mrs C in front of other patients or left bedpans piling up in the ward toilet, and upheld both complaints. However, we did not make any recommendations as the board had already taken action to address these failings. We did not find that the time the board took to provide the results of the test was unreasonable.

Summary
Mrs C, an advocacy worker, complained on behalf of her client (Mrs A) that hospital staff failed to adequately record and deal with a fall that Mrs A sustained in hospital. Mrs A said that staff had manhandled her, and had thrown her onto a bed, and that she was then denied medical treatment.

After consulting our medical adviser, we found that staff had not acted in accordance with moving and handling guidance and that they failed to appropriately record the circumstances of Mrs A's fall. We found, however, that staff were acting in Mrs A's best interests at the time by putting her back to bed rather than lowering her to the floor and obtaining a hoist which may have taken some time. We saw no evidence that Mrs A's safety was compromised by these actions. As the board had already taken action to prevent a repeat occurrence, we did not make any recommendations.

Summary
Mr C, an advocacy worker, complained on behalf of Mr A that his condition was not properly diagnosed and that he was prescribed a named drug inappropriately. He alleged that the consultant concerned had been dismissive and did not review Mr A again as promised.

We obtained advice from one of our medical advisers, who considered Mr A's clinical records. We established that the assessment of Mr A and his treatment were appropriate, as was the drug prescription given to him. However, we also found that follow-up arrangements were far too lengthy given Mr A's presenting symptoms, which were progressive. Our adviser said that arrangements should have been made sooner given that Mr A’s symptoms were unresolved and that the results of a procedure at the hospital required evaluation.

Recommendations
We recommended that the board:
• offer Mr A an apology for their failure to review him at an earlier date; and
• the consultant review his follow-up practice in similar circumstances.

Summary
Mrs C complained about the care and treatment she received at a dermatology clinic for a lesion on her breast. Mrs C developed a rash that spread to both breasts and was of the view that Dermol 500 (a moisturiser with antiseptic agent) was the underlying cause of scarring to her breasts. Mrs C was seen frequently over a five month period and was prescribed various topical creams. Mrs C also said that one of the doctors had not examined her and felt that, had he done so, the problems she experienced could have been avoided.

In response to the complaint, the board advised that they did not believe that this cream was the cause of the rash. However, they said that Mrs C had been advised to avoid using it.

We did not uphold Mrs C's complaint. Our medical adviser was unable to identify the cause of the rash, but considered that it was unlikely to be Dermol 500 as it is a moisturiser widely used for adults and children, and allergic reactions are very uncommon. The clinic had conducted a patch skin test but did not include the agents within Dermol 500. Whilst, therefore, there is a small possibility that an allergy could occur, we considered that the clinic took reasonable action in advising Mrs C to stop using it. Also, although it is unclear how thoroughly the doctor examined Mrs C, the clinical records reflected that a visual examination was carried out. We considered that a physical examination would not have been expected in this case.

We also considered that the strength of the topical steroid prescribed as a short-term measure was appropriate and would not have caused significant thinning of the skin. A biopsy result showed Mrs C's skin to be eroded in a relatively superficial way. We concluded that Mrs C's overall treatment was appropriate and that residual staining of the skin was likely due to the severe rash.

Summary
Mrs C went into labour in the early hours of the morning. She telephoned the maternity assessment unit and was advised to attend. After an assessment and test, the midwife told Mrs C that she was in early labour. She was discharged and advised to return to the unit at 12:00 that day. Shortly after arriving home, Mrs C called the unit again as her contractions were increasing and she was becoming more distressed. The midwife advised her to attend the unit. While getting dressed to go there, Mrs C felt her baby's head appear. Her husband helped deliver the baby and they were transferred to hospital by ambulance shortly afterwards.

Mrs C complained that the board put her and her baby's health at risk because of the quality of midwifery service provided. She was unhappy that staff could not find her health records when she first arrived at the unit. She was also unhappy at being advised to return home despite not feeling well due to having bad and regular contractions which were every five minutes. Mrs C said that the midwife had told her that, although she was in early labour, she should not give birth within the next 12 hours.

Mrs C also complained that, when she called the hospital again shortly after returning home she said that she was bleeding and involuntarily pushing. She said she was told that she was probably in early labour but could come to the hospital if she wished. Mrs C also raised concerns that the placenta was not removed before she arrived at the unit.

We took advice from one of our medical advisers, a midwifery specialist. Having looked at all the medical records and the advice given, we considered that it was reasonable for Mrs C to have been discharged. Whilst we had concerns about the midwife's comments regarding whether delivery was likely within a 12 hour period, we noted that the board have since taken steps to address this by discussing it with the member of staff involved.

Telephone records noted that Mrs C's contractions were increasing and that she was becoming more distressed but it was also noted that there was no reported bleeding or abdominal pain. We also established that, although the midwife did not believe delivery was imminent, Mrs C was offered an ambulance but declined because her husband was going to take her to the unit as soon as she got dressed. We considered that the retained placenta was managed appropriately in terms of the Scottish Emergency Maternity Care Course for non-maternity professionals. This was because Mrs C was stable and there was no evidence of third stage complications, such as haemorrhage.

Overall, although we recognised that Mrs C found events distressing, we concluded that her overall care was reasonable and appropriate.