Health

Summary

Mr C complained about the antenatal care which his wife (Mrs A) received at the Royal Infirmary of Edinburgh. Mr C felt that Mrs A was not appropriately monitored by the community midwives, that they had been difficult to contact for advice when Mrs A started to suffer from swollen legs, and that she went on to develop pre-eclampsia (a pregnancy-related condition involving a combination of raised blood pressure and protein in the urine) which required an emergency hospital admission.

We took independent advice from a midwife and found that Mrs A's antenatal care was shared between the community midwives and her GP practice. Mrs A was appropriately monitored during the antenatal period although the nursing documentation could have been clearer. We also found that appropriate advice was given that Mrs A should take paracetamol for her swollen legs and to seek further advice if the symptoms did not improve. Appropriate contact details were contained in Mrs A's nursing records. There was also no indication from the nursing records that Mrs A had reported symptoms which were suggestive of pre-eclampsia. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment he received in relation to a coronary artery bypass graft (a surgical procedure used to treat coronary heart disease) at the Royal Infirmary of Edinburgh.

We took independent advice from a consultant cardiologist (a specialist in diseases and abnormalities of the heart). We found that Mr C was identified as having ostial left anterior descending artery disease (a narrowing in the blood vessels of the heart) and that the initial choice of treatment for this, bypass surgery, was reasonable. Mr C then had an uncommon but recognised complication of bypass surgery. We found that the decision to perform a second procedure to implant a stent (a small tube used to keep passageways open) was reasonable. We also noted that there was no reason to believe that performing a stent procedure earlier would have translated to any clinical benefit for Mr C. We considered that the clinical care Mr C received was reasonable and did not uphold this aspect of his complaint.

Mr C also complained about aspects of his nursing care during his hospital admission when the stent procedure was performed. We took advice from a consultant nurse in cardiology. We found that Mr C was not prescribed appropriate pain relief and that there was contradictory evidence in the records around the management of his pain. Mr C's pain should have been managed better and the failure to do so was unreasonable. We also identified failings in record-keeping, in particular, a failure to complete care documentation, around communication with Mr C and his family, and his discharge from hospital. We considered that the nursing care Mr C received was unreasonable and upheld this aspect of his complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing provide him with reasonable pain relief, failures in record-keeping, and failing to provide him with reasonable nursing care. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Patients who are in pain should have their pain needs addressed as soon as possible. Following a surgical procedure, patients pain needs should be proactively addressed even though they are waiting to be clerked into the ward. Nursing staff should ensure the documentation of a patient's care following a surgical intervention should be completed. Nursing staff should maintain reasonable records, consistent with the Nursing and Midwifery Code of Conduct.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C complained about the care and treatment her late mother (Mrs A) received at the Royal Infirmary of Edinburgh. When Mrs A was admitted, it was recorded that she had known lung cancer and she was initially treated for pneumonia (inflammation of the lungs). It was subsequently planned that Mrs A would be discharged, but a CT scan showed that she had an accumulation of blood in her abdominal muscle. Mrs A later had a fall. She was monitored overnight, but died the following day.

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that the medical treatment provided to Mrs A had been reasonable. We did not uphold this aspect of the complaint.

Ms C also complained about the nursing care provided to Mrs A. We took independent advice from a nursing adviser. We found that there was no evidence of any failings that had led to Mrs A's fall in the hospital or that a specific injury sustained in the fall led directly to her death. A robust post falls assessment was also undertaken after the event, which did not indicate any specific injury.

Overall, the nursing care provided to Mrs A had been reasonable. However, there were gaps in the nursing notes provided. There was also a lack of evidence of communication with Mrs A's family. In addition, the board's response to Ms C's complaint did not address many of the points she had raised. Given these failings, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to provide evidence that nursing staff communicated with her appropriately. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Nursing staff should maintain records in line with the Nursing and Midwifery Council's guidance on record-keeping.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained about the care and treatment his late wife (Mrs A) received from the practice during a number of attendances.

We took independent advice from GP adviser. We found that the care provided to Mrs A by the practice, when she presented with a swelling in her groin and a lump on her breast, to be reasonable.

Mrs A had also attended the practice with a swelling in her neck. We found that there was a failure by the practice to document a full history relating to the neck swelling, how long it was there for, and to consider further investigation of the swelling and safety netting. We considered this to be below a reasonable standard and upheld this aspect of Mr C's complaint. However, we also acknowledged that by the time Mrs A presented with the swelling in her groin, she already had incurable cancer. While earlier referral for investigation of the neck swelling could have possibly led to an earlier diagnosis, it was unlikely to have changed Mrs A's overall outcome.

Mr C also complained that Mrs A had been treated in an unsympathetic and dismissive manner by the practice, and said that he and Mrs A were unaware that she had suspected heart failure. Our investigation found no evidence of this.

Mr C also complained about the way in which the practice had responded to his complaint. We found that the practice responded to Mr C within a reasonable time, and did not identify any inaccurate information in their response. We also acknowledged that the practice had offered to meet with Mr C. We did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failure to document a full history relating to Mrs A's neck swelling; how long it was there for; or to consider further investigation of the neck swelling and safety netting. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Relevant staff should ensure they review and are aware of General Medical Council Good Medical practice guidance and the Scottish cancer referral guidelines on Head and Neck Cancers.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mrs C, an advocate, complained on behalf of her client (Mrs B) about the medical and nursing care that Mrs B's late husband (Mr A) received at Wishaw General Hospital.

Mrs B was concerned that a urine sample was not taken around the time Mr A was admitted to hospital; that sepsis may not have been treated properly; that staff did not recognise the severity of a fall Mr A sustained; and an opiate painkiller was not given at a particular time. Mrs B was also concerned that; no falls assessment was carried out and wheelchair transportation was inappropriate after Mr A's second fall; record-keeping regarding a fall was contradictory and did not capture the severity; intravenous paracetamol should have been given instead of oral paracetamol; and Mr A's blood pressure and heart rate were not properly monitored.

We took independent advice from a GP consultant and from a registered nurse. We found that there was a failure to take a urine sample which the board had accepted and apologised for. However, overall we did not identify any significant failings in Mr A's medical care and did not uphold this aspect of the complaint.

However, we found that it was unreasonable that Mr A was not transported by trolley to have his scan carried out and that there was a failure to escalate his worsening blood pressure reading to medical staff. Therefore, we upheld the complaint that Mr A's nursing care was unreasonable.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs B for failing to escalate Mr A's blood pressure reading to medical staff; and for not transporting Mr A by trolley for his scan. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets

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

• Nursing staff should comply with the board's policy on deteriorating patients and NEWS escalation.
• Nursing staff should ensure that appropriate consideration is given to a patient's transportation following falls.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mrs C complained about the care provided to her late sister (Mrs A) when she attended Raigmore Hospital with gastric symptoms. Investigations were carried out into Mrs A's symptoms over two admissions. During the latter admission, Mrs A was diagnosed with a perforated bowel, thought to be related to cancer. Her condition deteriorated very quickly and she died from her illness.

We took independent advice from a consultant gastroenterologist (a doctor who specialises in the digestive system) and from a registered nurse.

We did not identify any failings in the medical management of Mrs A's condition or in the nursing care provided. We did not uphold this aspect of the complaint. However, we noted that the documentation of her care could have been more detailed and fed this back to the board.

Mrs C was also unhappy that board staff did not contact her regarding Mrs A's discharge from the hospital following her first admission. In response to Mrs C's complaint, the board confirmed that another family member had been told about the discharge and so there was no requirement for duplication of information. We did not uphold this aspect of the complaint.

Summary

Mrs C complained about the treatment which her late husband (Mr A) received at the Queen Elizabeth University Hospital following a fall, in which he sustained a fractured leg. Mr A was admitted for conservative treatment rather than surgery, however, a few days after admission, Mr A's condition deteriorated; he suffered a cardiac arrest and was taken to intensive care.

We took independent advice from an medical adviser. We found that initially Mr A received appropriate medical care in view of his presenting symptoms, but when Mr A's condition began to deteriorate, there was an avoidable delay by junior medical staff in seeking a more senior medical review for Mr A. While this may not have prevented the cardiac arrest or affected the final outcome, it would have allowed for the appropriate medical investigations to be instigated at an earlier time. Therefore, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to refer Mr A for a senior medical review at an earlier stage. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Staff should be aware of the need to refer patients for a more senior medical review when their medical condition deteriorates.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C complained about the nursing care that her partner (Ms A) received at Queen Elizabeth University Hospital while she was recovering from brain surgery. We took independent advice from a nursing adviser. We found that the nursing care provided to Ms A was reasonable and did not uphold this aspect of Ms C's complaint.

Ms C also complained about the medical care and treatment that Ms A received. We took independent advice from a consultant in acute medicine and from a consultant neurosurgeon (specialist in surgery on the nervous system, especially the brain and spinal cord). We found that there was a lack of documented medical assessments regarding Ms A's orientation/confused status, and when confusion was identified, this was not appropriately investigated and documented. We also found that there was no consultant medical review prior to Ms A's transfer from Queen Elizabeth University Hospital to another hospital. Therefore, we upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C and Ms A for the lack of documented medical assessments regarding Ms A's orientation/confusion status and the failure to carry out a consultant medical review prior to Ms A's transfer between hospitals. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Patients recovering from neurosurgery should have documented medical assessments of their orientation and where confusion is identified this should be investigated and appropriately documented.
• Where possible, in-patients should receive daily senior clinical review and these reviews should be documented.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr and Mrs C complained about the care and treatment their children (Child A and Child B) received at Royal Alexandra Hospital following their birth. They also complained about the level of communication with them about Child A and Child B's care and treatment.

We took independent advice from a paediatrician. We found that, overall, the care and treatment Child A and Child B received had been reasonable and we did not uphold these aspect's of Mr and Mrs C's complaint.

However, the board accepted that there had been failings in communication regarding some of the problems Child A and Child B had faced following their birth. We also found that there was a lack of documentation about the communication with Mr and Mrs C about Child A and Child B's care and we raised this with the board. We upheld these aspects of Mr and Mrs C's complaint but noted that the board had already apologised for these failings so made no further recommendations.

Summary

Mr and Mrs C complained on behalf of their child (Child A) about the care and treatment they received from the board's children and adolescent mental health services over several years. The concerns related to the stopping of treatment; the lack of support to aid Child A's understanding of a complex system and consenting to it; and lack of transparency regarding a number of matters. The board did not identify any failings in the care and treatment provided and explained this to the family.

We took independent advice from a consultant child and adolescent psychiatrist. We considered that there had been a reasonable amount of input at an appropriate level of seniority in place to make decisions in a complex case. We found that it was a reasonable course of action to stop a type of therapy and not carry out a risk assessment as there was evidence of engagement and future planning and no evidence of a high risk situation at this time. In addition, whilst the therapy was stopped, Child A continued to receive care from psychiatric and psychology services. In terms of consent, there was evidence in the clinical records to support that attempts were made by staff to tailor their approach towards Child A and we did not identify unreasonable practice. However, we did provide feedback to the board regarding ensuring that patients receive relevant information about their clinical condition. We also considered that further opinions were appropriately sought when the family questioned the clinical diagnosis in line with national guidelines. We did not identify any concerns regarding transparency in the clinical records or with the family. We did not uphold the complaint.