4. Mr D complains that the Trust's decision to place his mother, Mrs F on end-of-life care and stop active treatment on 19 October 2022 was incorrect.
5. Mr D says he is concerned Mrs F’s death may have been premature and less peaceful than it could have been had it not been for the failings. He says he has not been able to mourn his mother and he has lost respect for the NHS.
6. Mr D would like service improvements.
7. Mrs F was taken to the Trust’s Emergency Department (ED) by ambulance on 18 October 2022. She was experiencing confusion and had not been eating or drinking much. She also had low blood pressure and a low oxygen saturation. Mrs F’s medical history included respiratory disease, advanced kidney disease, and arthritis.
8. The Trust took blood tests and diagnosed Mrs F with pneumonia and acute kidney injury, meaning her kidneys had stopped working properly. Mrs F was transferred to the Trust’s Acute Medical Unit (AMU).
9. Mrs F sadly died on 24 October 2022.
13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something went wrong in the decision the Trust reached, or the care Mrs F received.
14. The NICE guideline on the care of dying adults in the last days of life sets out recommendations to support doctors to make a clinical judgement that an individual is reaching the end of their life. It explains there are changes in signs and symptoms that suggest an adult is in the last few days of their life. These changes can include agitation, a deterioration in level of consciousness, fatigue, and shallow breathing.
15. The guideline says doctors should consider treating a dying person who is experiencing ‘agitation’ and ‘anxiety’ with a benzodiazepine. This type of medicine slows down activity of vital organs and gives a person feelings of drowsiness, relaxation, and pain relief.
16. In the ED, Mrs F was treated with intravenous fluids, antibiotics, and steroids. Intravenous means the medicine and fluids was delivered directly into her vein. The Trust also treated Mrs F with oxygen. The records show Mrs F sadly did not respond to this treatment.
17. Mrs F was transferred to the AMU and was seen by a doctor just before 10pm. The doctor noted Mrs F’s breathing was shallow. He assessed her level of consciousness using the Glasgow Coma Scale. This assesses an individual’s ability to open their eyes, move, and speak. The doctor concluded that Mrs F was ‘unresponsive’ and was, sadly, dying.
18. The records show the doctor’s plan was for active treatment to stop and Mrs F to be given end of life care.
19. Our adviser said the doctor assessed Mrs F and made this decision in line with the NICE guideline. They said it was clear from the records that the doctor had seen the changes in signs and symptoms set out in the NICE guideline.
20. The records show on 19 October a doctor explained to Mrs F’s family that she had severe sepsis (a life-threatening reaction an infection), and her lungs, heart, and kidneys were not working as they should.
21. Mrs F was treated with morphine for pain relief and midazolam. Our adviser explained midazolam is a type of benzodiazepine. They said the Trust acted in line with the NICE guideline by treating Mrs F with these drugs.
22. Mr D was particularly concerned that Mrs F should not have been treated with midazolam because she had respiratory disease. Our adviser said the use of midazolam is not contraindicated (likely to be harmful) for people at the end of their life. This is set out in the NICE guideline. Our adviser explained all medication that is used to relieve distress and agitation at the end of life has the potential to cause slower breathing. They said this medication was important to ensure Mrs F was as comfortable as possible as she reached the end of her life.
23. We understand Mr D’s experience has caused him and Mrs F’s family distress and we do not underestimate how much of a difficult time this has been for all of them. We hope this statement reassures Mr D we have considered his complaint carefully and clearly explains our decision not to consider the issues further.
1. We have carefully considered Mr D’s complaint about the Trust. We recognise that the events leading to his mother’s death have caused him great distress.
2. We have seen no indication that anything went wrong in how the Trust reached its view that Mrs F was at the end of her life. The evidence we have seen shows the Trust acted in line with relevant guidance on recognising the signs and symptoms of dying person. The evidence shows the Trust cared for Mrs F in line with this guidance.
3. We thank Mr D for bringing his complaint to us and for the effort he has made to share his experience. Our decision is not intended to take away from his distress and upset. We hope the explanations provided in this statement have helped answer some of Mr D’s questions and given him some reassurance around the care his mother received.