Decision Report 201603721

Summary

Mrs C complained about the care and treatment provided to her father (Mr A) by staff at Ayr Hospital. She complained that full diagnostic tests had not been carried out when Mr A was in hospital on two occasions, and that signs of heart failure had been missed by staff. Mrs C also complained that Mr A had been prescribed with medication for his previously diagnosed Parkinson's disease (a progressive neurological condition in which part of the brain becomes more damaged over many years) without a full examination and consultation, and that the medication he was given caused adverse side effects. Mr A was discharged with a full care package and died shortly afterwards.

During our investigation we took independent medical advice from a consultant physician and a specialist Parkinson's disease nurse. We found that whilst the clinical treatment provided to Mr A had generally been reasonable, the board failed to consider a diagnosis of pulmonary embolism (blood clot in the lungs) and carry out the diagnostic test for this. Therefore we upheld this aspect of Mrs C's complaint.

We also found that when Mr A was prescribed with medication for Parkinson's disease, he was not appropriately assessed by the Parkinson's nurse and that there was no documented justification for the prescription. We also found that side effects were not appropriately discussed with Mr A or his family, and that prescribing guidelines were not appropriately followed. Given this, we upheld this aspect of Mrs C's complaint.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failures identified by this investigation;
• draw the adviser's comments regarding the alternative diagnosis of pulmonary embolism, and the carrying out of the diagnostic test, to the attention of the relevant staff;
• apologise to Mrs C for the failings identified by this investigation;
• consider implementing in-patient guidelines for staff regarding the care of people with Parkinson's disease in an acute setting, in order to provide a framework to help with assessment and drug choice; and
• consider implementing assessment and prescribing competencies to support nurses working in this setting, to ensure they have the correct knowledge.