Decision Report 201507530

Summary

Mrs C was recovering from breast cancer and had previously been diagnosed with truncal lymphedema (fluid affecting the trunk and/or breast following breast cancer treatment). Mrs C had therefore understood that she should be treated urgently if she became unwell. As she was experiencing pain between the shoulder blades, Mrs C was taken by ambulance to A&E at Monklands Hospital, where she was assessed by a registrar and a consultant, and then discharged with a prescription for pain medication.

Mrs C complained there was a failure to carry out an adequate clinical assessment, a failure to provide adequate nursing care and an unreasonable delay in assessing and treating her. Mrs C was also unhappy about the attitude of staff towards her. The board said that Mrs C had behaved unreasonably towards members of A&E staff.

We took independent advice from a medical adviser and a nursing adviser. We found that while the majority of Mrs C's care and treatment was reasonable and she suffered no adverse outcome, the doctors who treated Mrs C should have sought information on truncal lymphedema, and there was no evidence they did so. In addition, the registrar had failed to record their consultation with Mrs C in her medical records. Therefore, we upheld Mrs C's complaint that there was a failure to carry out an adequate clinical assessment. However, we did not find evidence that there had been a failure to provide Mrs C with adequate nursing care or that there had been an unreasonable delay in assessing and treating her, and we did not uphold this part of Mrs C's complaint.

Mrs C attended the out-of-hours service at Monklands Hospital approximately two weeks later because she was concerned about having truncal lymphedema and that she possibly had shingles. Mrs C complained about the care and treatment she received and about staff attitude towards her. The advice we received from both advisers was that the care and treatment Mrs C received was appropriate, and we were unable to reach a conclusion on her complaint about staff attitude due to conflicting accounts. We did not uphold this part of Mrs C's complaint.

Recommendations

We recommended that the board:

• consider organising a consultation between A&E and the oncology department at Monklands Hospital and Mrs C's GP with a view to putting a care plan in place and to sharing the plan with her;
• remind relevant staff of the importance of ensuring that consultations and discussions with a patient are recorded in the patient's medical records; and
• provide evidence that nursing staff in A&E have been reminded of the need to routinely record a patient's pain score.