Decision Report 201302826

Summary

Mr C complained on behalf of his late wife (Mrs C) about the care and treatment she received in University Hospital Ayr when she was admitted there apparently suffering from epileptic seizures. He complained that staff had not taken reasonable account of Mrs C's stress and anxiety when she was first admitted to hospital, and that she had not received adequate care and treatment on the ward.

We took independent advice from two of our advisers - a nursing adviser and a neurology adviser (a specialist in the science of the nerves and the nervous system, and of the diseases affecting them). Our neurology adviser said that Mrs C was suffering from a complex, unusual condition, which the neurologist involved in her care did not diagnose at first. Mrs C's initial diagnosis was incorrect, but had been difficult due to her unusual condition and existing medical conditions. Nursing advice indicated that staff noted Mrs C's anxiety, and took appropriate action to try and alleviate this, although Mrs C should have been given the option of treatment for nicotine withdrawal when she was first admitted. We concluded that, overall, the care and treatment she received was reasonable, and that staff responded to her situation appropriately.

Mrs C was later transferred to Girvan Community Hospital. Mr C complained that, while she was there, Mrs C's medication was altered without his knowledge, leading him to continue to give her particular medication while she was at home at weekends, although she was no longer taking it in hospital. During this period, Mr and Mrs C felt that the medication had a positive effect on her and, when it became apparent that the hospital had stopped it, they asked for it to be reinstated. This request was declined, and Mr C was unhappy about this.

Our adviser noted that the medication was no longer clinically necessary, given Mrs C's second diagnosis, and on this basis it was reasonable to withdraw it. However, he said that it would have been appropriate for staff to have given greater consideration to reinstating the medication when Mrs C clearly indicated that was what she wanted. He was also critical of the lack of evidence of any discussion with Mr and Mrs C before or after the withdrawal of the medication.

Recommendations

We recommended that the board:

• remind staff of the importance of discussing nicotine withdrawal and any available treatment options at the time of admission and as appropriate thereafter;
• remind staff of the importance of discussing changes in medication with patients and their relatives, and documenting these discussions;
• take steps to ensure that Girvan Community Hospital provide up to date information to carers in relation to medication when patients are allowed home during an admission to hospital; and
• apologise to Mr C for their failure to discuss medication with him, to respond appropriately when Mrs C indicated her desire for the medication to be reinstated, and for the distress this caused Mr and Mrs C and their family.