Decision to discharge
15. Mrs B has told us that the discharge of her husband on 10 February 2024 was unsafe, given his condition, and the concerns she raised with the Trust were continually ignored.
16. Mrs B also told us the Trust discharged Mr A with medication that his care home was unable to administer, and he was unable to swallow. She was worried the nursing home would not be able to care for him and wanted him to remain in hospital for a few more days.
17. We can see on 10 February the Trust took Mr A’s observations at 10.51am. His temperature was 39 degrees at this time, and he had a heart rate of 111 beats per minute.
18. From these observations, the Trust calculated a National Early Warning Score (NEWS2). This is a national tool, used to assign numbers to physiological parameters to determine the appropriate clinical response to their clinical status and the frequency of future observations. Mr A’s NEWS2 was documented to be three at this time. We can see the Trust discharged Mr A at 2.44pm that afternoon.
19. Our Physician Adviser said given Mr A’s observations were high, it would have been good medical practice and within NEWS2 guidance to carry out further observations after four hours. The Trust discharged Mr A prior to this happening.
20. In NEWS2 guidance, the clinical response to a NEWS2 score of 1 – 4 states monitoring of patients should take place every 4 to 6 hours.
21. The Trust said Mr A was medically fit for discharge. However, it recognised his temperature was recorded at 39 degrees and accepted that a further review may have been appropriate prior to his discharge.
22. The Trust partially upheld this element of the complaint and said it has stressed to nursing staff the importance of reviewing patients thoroughly where relatives are concerned and where observations have changed.
23. We have considered the impact of this. Our Physician Adviser explained although there were indications the Trust should have carried out further observations, there is no evidence to suggest Mr A was not fit for discharge. Our physician explained although Mr A’s temperature was 39 degrees this would have been expected, given he had tested positive for flu.
24. It was documented the Trust gave Mr A a NEWS2 score of three. NEWS2 guidance says a score of three suggests a low risk. Our Physician there was no evidence to suggest Mr A should have remained in hospital and is satisfied he was fit for discharge.
25. We can see from the clinical records the Trust were in contact with Mr A’s care home, and they were happy to take him back on 10 February 2024. This is in line with hospital discharge guidance where it states, ‘patients should be discharged to the best place for them to continue recovery (if needed) in a safe, appropriate and timely way’.
26. It is clear Mrs B was extremely concerned at her husband’s discharge at the time and given he died four days later, we appreciate why she would feel why the discharge was unsafe. From the evidence available and the advice, we have received from our Physician Adviser we are satisfied the Trust’s discharge was appropriate and in line with the relevant guidance.
Concerns about medication when discharged
27. Mrs B told us Mr A was unable to swallow his medication, and his care home were unable to administer it.
28. We can see from the medical records that Mr A appears to have been taking medication in hospital without any problems. He was also eating and drinking without any issues. As such, there is no evidence here to suggest he had any issues swallowing.
29. Our Nursing Adviser explained given there was no evidence to suggest Mr A was unable to take the medication in hospital, the Trust’s actions were appropriate in respect to medication.
30. NMC code of conduct guidance states:
‘Nursing staff should make sure that patient and public safety is not affected. You work within the limits of your competence, exercising your professional ‘duty of candour’ and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.’
And:
‘They put the interests of people using or needing nursing or midwifery services first. They make their care and safety their main concern and make sure that their dignity is preserved, and their needs are recognised, assessed and responded to’.
31. We have seen no evidence to suggest the Trust has fallen outside of these guidelines, or that Mr A should not have been discharged with the medication he was prescribed. Furthermore, the care home expressed no concerns about Mr A’s discharge and were happy for him to return.
Discharge summary
32. In response to the complaint, the Trust has accepted that it failed to provide a discharge summary to Mr A or the care home to which he was going back to. It apologised for this error.
33. A discharge summary letter was written and sent to Mr A’s GP on 14 February, however it is accepted that Mr A should have been given a discharge summary at the point he was discharged home. The Trust has said unfortunately the summary was not written prior to his discharge.
34. We discussed this with our Nursing Adviser who explained discharge summaries are important medical documents that summarise a patient’s hospital admission and act as an important handover document.
35. As the Trust failed to provide a discharge summary it is clear it failed to adhere to hospital discharge and community support guidance which outline the importance of discharge summaries.
36. As such, we looked at the impact of its failure to provide a discharge summary. Given the clinical advice we have received we are satisfied there was no clinical or lasting impact from this. This is because we are satisfied the discharge was safe.
37. Furthermore, the Trust has apologised for its error and reminded all its staff the importance of ensuring patients discharge summaries are written prior to discharge, and that they have a copy of the letter when discharged.
38. This is in line with NHS complaint standards, which state; ‘Organisations support and encourage staff to be open and honest when things have gone wrong or where improvements can be made. Staff recognise the need to be accountable for their actions and to identify what learning can be taken from a complaint. They are clear about how the learning will be used to improve services and support staff’.
39. As such, although we appreciate the actions of the Trust here made an extremely difficult situation worse for Mrs B, given her concerns about the discharge, we are satisfied the Trust has done enough here.
40. There is no doubting the distress and upset Mrs B says she has experienced because of the Trust’s actions. We would like to thank her for highlighting her concerns and highlighting the error made by the Trust regarding the discharge summary, and hope she is reassured as we are, by the apology and the service improvements.
41. Finally, we hope our consideration of Mrs B’s complaint gives her the explanations she is seeking and will help bring her some closure to this traumatic time.