A practice in the Essex area

3. Miss A complains about the care and treatment the Practice provided between March 2021 and May 2021, when she was suffering with an abscess (a painful collection of pus, often due to infection) on her left breast. She says the Practice nurse wrongly prescribed her with an eye ointment – Maxitrol - to apply. She told us the abscess had almost healed, but applying the ointment made the wound reopen and get worse.

4. Miss A says this caused her physical discomfort and mental distress. She was unable to go to work and struggled with caring for her five children. Miss A also says she experienced depression, anxiety and stress for over 12 months.

5. As an outcome to her complaint Miss A wants an apology and financial compensation for her discomfort and anxiety.

6. Miss A’s medical records show she has experienced abscesses on both breasts, on and off since 2016. The Practice referred her for specialist care at a secondary care breast unit, drainage and antibiotics, when necessary.

7. She told us, on the occasion complained about, the wound was healing fine until 11 March 2021. At that time, the Practice nurse prescribed Maxitrol to treat the wound.

8. She says this resulted in the wound reopening and getting worse. She says the breast clinic told her the medicine was not appropriate for her wound. She complained to the Practice about her treatment on 20 April 2021.

12. When looking at whether there have been failings in the service provided, we look to see what should have happened in the circumstances. We look at what did happen and consider whether it fell so short as to be a failing. If we see evidence of failings, we look at whether the claimed impact can be linked to those failings.

The use of Maxitrol

13. Miss A began using Maxitrol on 11 March 2021. On 1 April, her medical records show the wound was almost healed. On 6 April, Miss A raised concerns with the Practice that the wound was infected again. On 12 April, she raised concerns Maxitrol was making the wound worse. On 15 April, the Practice agreed she should stop using the cream. They re-referred her to the breast unit, requested a blood test and prescribed antibiotics.

14. Our adviser referred us to Web MED, an online pharmacy, which names Maxitrol as a steroid treatment for conditions relating to bacterial eye infections. The product contains antibiotics and an anti-inflammatory corticosteroid (often known as steroids).

15. Web MED clearly advises the cream only treats and prevents bacterial eye infections. Maxitrol can give common side effects of stinging or burning of the eyes, irritation, redness and itching when applied. Our adviser told us the potential effects to a wound could be worse. The medicine is not licensed for use on other parts of the body. They also explained steroid use is known not to help wound healing and can cause dehiscence (splitting or bursting open of a wound).

16. We also referred to information in the ‘Annals of the Royal College of Surgeons’. This explains the use of steroids on wounds is not considered ‘general or good surgery’ because it can cause a wound to become prone to infection.

17. The nursing code says practitioners should, ‘Make sure that any information or advice given is evidence-based including information relating to using any health and care products’.

18. Our view is there are failings by the Practice. Maxitrol cream is not an appropriate prescription in these circumstances. We have not seen recommendation for its use anywhere other than the eyes. And, the Practice did not follow the nursing code.

19. To consider the impact of this failing, we looked at how the use of, and stopping the use of, Maxitrol potentially affected the healing of the wound.

20. Miss A’s medical records show she was prone to breast abscesses or infection and had been suffering on and off with the complaint since 2016. Records also show Miss A was unable to self-care for the wound and was not always proactive in attending appointments and taking prescribed antibiotics. In February 2021, records show the Practice explained to her the importance of taking responsibility for her health by taking the prescribed antibiotics and attending appointments to have the dressing changed regularly.

21. Records on 1 April show the wound had almost healed. By 6 April Miss A was raising concerns about re-infection. We see the days between these dates were the Easter holidays that year and the dressing had not been changed.

22. On 15 April, the use of Maxitrol was stopped and Miss A began taking antibiotics. On 21 April it is recorded the wound is healing well. By 4 May the wound was totally healed.

23. Considering the potential for a steroid to make a wound prone to infection, we consider it is likely the use of the cream contributed to reinfection. Miss A’s personal history shows she is vulnerable to infection and sometimes unable to self-care efficiently. This, along with the public holiday, must also be taken into account.

24. Miss A told us about the impact the wound had. She was too embarrassed to go to work as the wound was weeping and smelled. She also struggled with caring for her five children and was unable to have a full bath.

25. We were sorry to hear Miss A was in pain and struggling with daily activities. While using the cream likely contributed to infection, we cannot say it was the only cause of the wound becoming reinfected and of the impact described.

26. Our decision is there was a failing by the Practice in using Maxitrol to treat the wound and it is more than likely this contributed to the claimed impact. We partly uphold the complaint.

27. As the Practice has not accepted failings, it has not done anything to put things right.

1. The Parliamentary and Health Service Ombudsman has carefully considered Miss A’s complaint about a practice in the Essex area (the Practice). We are sorry to learn there was reason for Miss A to complain. Our final decision is we find failings by the Practice in prescribing Maxitrol. Our view is the use of the cream was a contributing factor in the reinfection of Miss A’s wound and we partly uphold the complaint.

2. To put things right, we recommend the Practice accept the failings. We also recommend the Practice apologise to Miss A in writing for prescribing the cream which likely contributed to re-infecting the wound. The Practice should show how it has used Miss A’s complaint for learning. We do not consider financial compensation to be appropriate.

28. To make recommendations, we refer to our ‘Principles for Remedy’. These state that where poor service or fault has led to injustice or hardship, the organisation responsible should take steps to put things right.

29. We recommend the Practice:

• accept the failing related to prescribing Matrixol • apologise to Miss A for the prescription likely contributing to reinfection of the wound • show how it has used her complaint for learning.

We do not consider financial compensation to be appropriate.

30. We hope the work we have done on Miss A’s complaint reassures her about the actions of the Practice and the impact on her health.