Decision Report 201800619

Summary

Mrs C complained about the out-of-hours care provided to her father (Mr A). Mr  A was seen at home by out-of-hours GPs and had been undergoing treatment for constipation in the days prior to this. The GPs considered that Mr A's reported symptoms were related to constipation. Mr A was later admitted to hospital where a catheter was fitted to drain retained urine from his bladder. Mrs C complained that the out-of-hours GPs had missed Mr A's urinary retention and prescribed inappropriate treatment as a result. The board acknowledged that an enema (a  procedure in which liquid or gas is injected into the rectum) that Mr A was prescribed was not appropriate and was unlikely to have been of any benefit in his case. This matter had been taken forwards with staff for reflection and learning.

We took independent advice from a GP. We found that there had been no indication that Mr A was suffering from urinary retention at the time he was seen and that the approach taken at the second out-of-hours visit was reasonable. However, we found that an enema had been inappropriate in Mr A's case and that a rectal examination should have been carried out during the first visit. On balance, we upheld Mrs C's complaint.

Recommendations

What we said should change to put things right in future:

• Rectal examinations should be carried out when clinically indicated in patients presenting with unresolving constipation.