Summary
Mr C had a hip replacement operation at Raigmore Hospital. During the operation, he was aware that the first attempt to insert the implant into his hip had not been successful, and the surgeon had tried again. This had prolonged the time he was in theatre, and, given the length of time the operation was taking, Mr C had asked for further anaesthesia for the pain. He found the experience to be very distressing and complained that the board had not provided him with a reasonable standard of care.
I took independent advice from two advisers; one a consultant in orthopaedic surgery (adviser 1) and the other a consultant anaesthetist (adviser 2). Whilst there were some difficulties during the procedure, of which there is more detail in my full report below, adviser 1 considered that the standard of surgery was reasonable. However, adviser 2 reported that Mr C was uncomfortable for over an hour until the anaesthetist administered a general anaesthetic, and it would have been reasonable for this to have been undertaken earlier. Based on this, I upheld Mr C’s complaint about the care he received in his operation.
Mr C was discharged from hospital, and he was given aspirin to take. However, around two weeks later he was readmitted to hospital with a pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs).
There are national guidelines, issued by the Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence (NICE), which relate to the use of treatments to prevent VTE (the formation of blood clots in the vein). These guidelines state that aspirin is not considered an adequate treatment for reducing the risk of VTE for patients in hospitals.
The advice I received from adviser 1 is that the failure to follow the guidelines on treatment following his surgery led to a significant injustice to Mr C in that he suffered a life-threatening condition which required another admission to hospital for treatment. The surgeon who carried out the surgery had noted in Mr C’s operation note that he should receive anticoagulant therapy but another member of staff had discharged Mr C with aspirin. However, the surgeon had gone on to tell my complaints reviewer that it was common throughout Scotland for aspirin to be provided for patients who had undergone joint surgery, even though this is against recognised SIGN guidelines. The board confirmed to my complaints reviewer that there was no specific board policy on this, but that if anticoagulant therapy wasn’t provided to a patient, this should be documented and explained by the clinician taking that decision.
I am very concerned not only that the relevant guidelines were not followed in Mr C’s case, but also about the board’s practice in general. It remains unclear to me if the board have a coherent policy that is being followed within Raigmore Hospital and beyond. As a result, an urgent review is required. I also intend to write to the Chief Medical Officer to draw their attention to my concerns about the use of aspirin and its potential implications for patient safety which have come to light in the course of my investigation.
Redress and recommendations
The Ombudsman recommends that Highland NHS Board:
- bring adviser 2’s comments in relation to anaesthesia to the attention of relevant staff;
- review as a matter of urgency the practice to ensure that its surgeons take into account the relevant guidelines on VTE prophylaxis;
- review its standard operating procedures concerning VTE prophylaxis for patients on discharge taking into account the relevant guidelines; and
- apologise to Mr C for the failures this investigation identified.