14. 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 has gone wrong.
Failure to carry out an ultrasound scan
15. Mrs K was admitted to the Trust after a fall. She had a CT scan. Mr K told us he was concerned the Trust did not perform an ultrasound scan, to check if there was any internal bleeding from her fall.
16. The CT scan showed she had fractures of bones in her pelvis. There was no mention of bleeding in this scan.
17. When she was examined in ED, the doctor documented a normal abdominal examination. This means there were no obvious signs of injury inside her abdomen.
18. GMC Guidance says at section 15: ‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must: a) adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient b) promptly provide or arrange suitable advice, investigations or treatment where necessary’.
19. Our adviser noted the Trust had examined and assessed Mrs K and not seen any indication she needed an ultrasound scan. From our discussion with our adviser, we understand an examination by a doctor, and a CT scan to look at her fractures and any other injury would be the investigations that should have happened here.
20. As we have explained above, there is evidence these investigations took place. The evidence from these investigations was that there was no sign of bleeding or abdominal injury. We consider this indicates the Trust had acted in line with GMC guidance and carried out the relevant investigations for her pelvic fractures. There are no indications of a failing here.
Administration of anticoagulant medication without checking if she was bleeding
21. On 28 May, the Trust assessed Mrs K’s risk of a blood clot, using its VTE assessment form and determined she needed anticoagulant (blood thinning) medication to prevent this.
22. Mr K told us he was concerned the Trust gave her this medication without checking if she was bleeding internally first.
23. The VTE assessment says medication is needed if someone has a significant reduction in mobility, which Mrs K had. The form lists conditions in which patients are at increased risk of bleeding, and Mrs K did not have any of these. As a result of the assessment, the Trust concluded she needed these injections.
24. The evidence indicates the Trust carried out this assessment in line with its VTE policy. Our adviser confirmed they could not see any reason Mrs K should not have been given anticoagulant medication.
25. Mrs K had regular assessments and regular blood tests during her stay at the main hospital and the rehab hospital. Her haemoglobin remained stable and there were no clinical signs of bleeding, until she vomited blood on 7 July. Haemoglobin is a protein in red blood cells. Its levels in the blood can indicate whether someone has lost blood. After discussing with our adviser, we consider the Trust acted in line with GMC guidance section 15 above, in providing regular assessments and monitoring her for any signs of bleeding.
26. Having considered everything, the evidence indicates no failings by the Trust in deciding to give Mrs K anticoagulant medication.
Conclusion
27. We understand this has been a very difficult situation for Mr K. He told us how the loss of Mrs K has affected him after sharing the wonderful 70 years they had together.
28. We have considered all the available evidence and can see no indications the Trust did anything wrong.
29. We thank Mr K for bringing his complaint to us. We hope he can be reassured that Mrs K’s care was in line with guidance.