Decision Report 201402748

Summary

Mr C complained on behalf of his daughter (Ms C) about the treatment that her mother (Mrs A) received at the Royal Infirmary of Edinburgh. Mrs A was admitted to A&E suffering with back pain, vomiting and palpitations. It was considered that she may have had a kidney infection with systematic septic response (a potentially life-threatening condition triggered by an infection). Mrs A was treated with antibiotics and fluids before being admitted to the acute medical unit where she was assessed. It was then decided to withhold the antibiotics until the source of the infection had been identified. Mrs A was admitted to a ward the following morning and test results showed that she was suffering from a urinary tract infection which was then treated. Mrs A's condition deteriorated and she had to be admitted to intensive care. As Mrs A's liver was failing, a transplant was organised. However, she remained very ill following this and later developed a perforation in her bowel. Mrs A died in hospital as a result of her illness.

Mr C asked us to investigate his concerns about Mrs A's treatment, particularly the prescription of antibiotics during the initial stages. Mr C was also concerned about record-keeping and communication with the family during Mrs A's time in hospital. After taking independent advice on this case from a consultant in general medicine, we upheld Mr C's complaint about medical treatment. We found that there had been a delay in the initial administration of antibiotics in the A&E department. Our adviser said that it would have been reasonable to continue to treat Mrs A with antibiotics while awaiting test results to determine the source of the infection. Our adviser found that the board had not followed their sepsis protocol as, in addition to the issues around administration of antibiotics, blood cultures were not taken until two days after Mrs A's admission to the hospital. We found that other aspects of Mrs A's treatment were reasonable. We did not uphold the second part of Mr C's complaint as we found no evidence that the communication with family members was unreasonable.

Recommendations

We recommended that the board:

• apologise to Mr C and Ms C for the failures identified in the initial management of Mrs A's condition;
• ensure that this case is included for discussion at the next appraisals of the doctors who made the antibiotic prescription decisions; and
• ensure that staff at the acute medical unit are reminded of the need to maintain accurate contemporary records.