Pain relief
9. Mr A says that during an ablation procedure performed on 5 February 2024, he was in pain and discomfort. He says he made the practitioner aware at the time, but the Trust did not provide sufficient pain relief for the procedure.
10. We reviewed Mr A’s clinical notes from the procedure with our adviser to see if the Trust followed guidelines on his pain relief at the time.
11. The Trust used levobupivacaine (a long-acting local anaesthetic used to make a specific area of the body numb or pain-free before and after surgery) as the local anaesthetic. In addition, it administered sedation medication. There is no note in Mr A’s records to say that he complained about pain at the time or whether there was any additional requirement for sedation or local anaesthetic.
12. Safe sedation guidelines simply recommend use of local anaesthetic and sedation if needed. There is no record from the nursing documentation of any ongoing pain. Mr A says that he ‘started without sedation when the ablation was attempted due to the pain’.
13. Mr A’s notes show that the Trust gave him sedation prior to the procedure starting and the procedure was not carried out at any stage without sedation. There is also no evidence in Mr A’s notes that he was in any discomfort during the procedure.
14. We have reviewed the records and the guidelines available and we can see no indication that the Trust failed to provide Mr A with sedation or anaesthetic in line with guidelines. We will not proceed further with this aspect of the complaint.
Discharge
15. The Trust discharged Mr A from its care on 20 January 2025. He says the Trust should have referred him to another consultant instead of discharging him.
16. The Trust discharged Mr A following a discussion at a multidisciplinary team meeting (MDT) where it showed that his heart rhythm was well-controlled by the medication dronedarone (an anti-arrhythmic medication used to treat patients with a history of atrial fibrillation).
17. Our adviser explained that clinically there was no reason for him to remain under the care of a cardiologist. The MDT showed the supra-ventricular tachycardia (a type of arrhythmia where the heart suddenly beats very fast (over 100 beats per minute)) is a safe rhythm but can be annoying. Dronedarone is an effective drug to prevent it occurring, so as Mr A was symptom free on medication, then the discharge would be satisfactory, and he does not need further review.
18. This would be in line with GMC guidelines which says that when providing good clinical care doctors:
‘must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options.
In providing clinical care you must: • adequately assess a patient’s condition(s), taking account of their history, including • symptoms • relevant psychological, spiritual, social, economic, and cultural factors the patient’s views, needs, and values
19. The Trust carried out a review of Mr A’s condition prior to him being discharged and not unreasonably decided he needed no further treatment. We cannot see that the Trust has failed to follow guidelines in this instance, and we will take no further action on this aspect of the complaint.
20. We do understand how worried Mr A has been about his heart condition. We hope we have been able to reassure him that it was safe to be discharged from the Trust’s care.