Decision Report 201508567

Summary

Mrs C complained about the care and treatment of her late mother (Mrs A) when she was admitted to the Royal Infirmary of Edinburgh with a urinary tract infection. Mrs A was also treated for a bacterial infection (staphylococcus aureus) and Mrs C raised concerns that medical staff did not adequately investigate the cause of this infection and relied upon the administration of strong antibiotics, which she considered wiped out her mother's immune system. Mrs A was subsequently diagnosed with a further bacterial infection (clostridium difficle) and, although plans were being made for her discharge from hospital, she suffered a gastrointestinal bleed and died two weeks later. We obtained independent advice from a consultant physician, who advised that most aspects of Mrs A's medical care were reasonable, including the investigation of her infections, the decision to treat with antibiotics and the management of her symptoms. The adviser did not consider that Mrs A's death could have been avoided. However, the adviser did query the initial choice of antibiotic and was also critical of the fluid management. In light of this, we upheld this aspect of the complaint.

Mrs C also complained about the standard of nursing care, including concerns about lack of available staff to provide assistance when required, dementia awareness and continuity of care. We obtained independent nursing advice. The adviser identified significant gaps in the recorded care of Mrs A, and a lack of care planning to meet Mrs A's changing needs. The nursing adviser did not consider it clear that staff understood how Mrs A's dementia affected her or took this into account in her care. We upheld this aspect of the complaint.

Mrs C raised further concerns about the hygiene and infection control measures in place on the ward. The available medical records did not provide sufficient evidence of the specific allegations of poor hygienic practice but we noted that the board had accepted and apologised for poor hygiene standards in Mrs A's care. We also upheld this aspect of the complaint.

Mrs C complained that the record-keeping in relation to her mother's care was inadequate. We received advice that the record-keeping fell below a reasonable standard and so we upheld this aspect of the complaint. We also upheld Mrs C's complaint that communication was inadequate, on the basis of a lack of evidence to show that nursing staff communicated reasonably with the family. In some instances we considered that the board had already taken appropriate action to address the identified failings and, in others, we made some recommendations.

Recommendations

We recommended that the board:

• confirm that the use of appropriate antibiotics will be highlighted to junior doctors as part of their induction process;
• confirm that the findings of our investigation will be reflected upon by the relevant consultant(s) as part of their annual appraisal;
• remind ward staff about the importance of completing fluid intake / output charts;
• apologise to Mrs C's family for the poor record-keeping in relation to Mrs A's care; and
• demonstrate to us that record-keeping on the ward is now of a reasonable standard.