Kidney dialysis
12. Miss E complains that staff told her to look up dialysis on google when she asked for an explanation.
13. The GMC guidance says that medical professionals should give patients the information they want or need in a way they can understand. This includes information about their condition(s), likely progression, and any uncertainties about diagnosis and prognosis. It also includes options for treating or managing the condition, and the benefits, risk, and likelihood of success for each option.
14. The guidance also says that medical professionals should listen to patients and encourage open conversations about their health, responding honestly to their questions. Information medical professionals give to their patients should be clear, accurate and up to date. Medical professionals should also check patients understanding and allow them time to make informed decisions.
15. We think the initial conversation with Miss E did not follow this guidance. There is a note which mentions an apology regarding a comment from the renal team. The records do not say what this comment was but it may have been in reference to the comment Miss E has complained about. We can see subsequent conversations were more detailed but our surgical adviser has highlighted there is a lack of evidence which they would expect to see about what was said in these conversations.
16. Telling Miss E to look up information herself instead of answering her questions honestly, and providing clear, accurate and up-to-date information does not appear to be in line with guidelines. We have therefore seen an indication of a failing here.
17. We have gone on to consider the Trust’s response. The Trust has acknowledged that such a response was inappropriate and it apologised for Miss E’s experience. It also said steps had been taken to reinforce the importance of effective communication and guidance in order that this does not happen again.
18. Our NHS complaint standards set out how organisations providing NHS care should approach complaint handling. These standards say that organisations should see complaints as an opportunity to develop and improve its services and people. It says responses should be fair and accountable, setting out what happened and whether mistakes were made. It should set out how the organisation is accountable and take action to make sure any learnings are identified and used to improve services.
19. We consider the response from the Trust is in line with the Complaint Standards. It acknowledged it made mistakes, and it was accountable for them. It apologised to Miss E for the distress its actions had caused, and it identified learning and set out actions taken to improve services.
Discharge
20. Miss E complains that she was not provided with information what she could or could not do after her surgery when she was discharged.
21. As above, the GMC guidelines say that medical professionals should give patients the information they want or need in a way they can understand. This includes information about their condition(s), likely progression, and any uncertainties about diagnosis and prognosis. It also includes options for treating or managing the condition, and the benefits, risk, and likelihood of success for each option.
22. The records say that Miss E was instructed by a Colorectal health care assistant (HCA) on how to change her stoma pouch and stoma care, including her diet. The next day the HCA noted that Miss E changed her stoma independently and she was discharged from stoma teaching. The HCA also noted that all discharge information was given to Miss E and discussed and contact details were given should she have any concerns.
23. In the Trust’s response it has explained that this information was paperwork which included guidance and advice on bowel cancer discharge following surgery, and colostomy advice for managing her stoma. This also included guidance on recognising reg flag symptoms, expected signs and consequences, pain management, lifting and driving restrictions, and dietary advice. The Trust has said that this also included information on bathing and general advice on activity levels, and fatigue.
24. It appears that the information given to Miss E on discharge about managing her condition was in line with guidelines. It seems Miss E was taught to manage her stoma prior to discharge. It also seems the Trust provided paperwork which outlined symptoms to look out for, advice on recovery and contact information should she have any concerns.
25. We can see in the records that Miss E seems to have used this information, as she called for the Colorectal nurse for advice later in the month after being discharged.
26. We appreciate that Miss E will not agree. We are sorry to hear that she felt under informed and therefore under prepared when she was discharged from hospital. We have not seen an indication of a failing here.
Medication
27. Miss E complains that she was not provided with her medication when she was discharged, and that staff were rude and unhelpful when she tried to arrange delivery of her medication.
28. NHS guidelines says if the patient needs any medication to take home they will usually be given enough for at least seven days. The Trust should also send a letter to the patient’s GP which includes information about the medication. The guidance also says the patient should make sure they have the medication they need.
29. There was a delay in completing Miss E’s discharge letter and take home medication list. There are two notes in the records which state that Miss E was aware of this delay, and the doctor had planned to complete this.
30. A note later in the evening stated that the medications were not available that day but Miss E wanted to go home regardless. The notes confirm the medications were ready in the late afternoon of the next day.
31. We do acknowledge that a delay in her medication being available would cause Miss E frustration. It appears that the Trust acted in line with the guidelines. Although there was a delay, it arranged for Miss E’s medication to be provided to her. Miss E decided to leave the hospital without it.
32. The NICE guidelines say that health care professionals should recognise the individual, tailor services to their needs, preferences and values. Advice should be individualised as much as possible. The Trust arranged for Miss E’s medication to be delivered to her home. This is in line with the NICE guidelines.
33. Miss E tells us that while discussing the delivery of her medication the staff were rude to her. There is not a record of these conversations. We understand that staff being rude, and unhelpful would cause Miss E distress and frustration.
34. We have gone on to consider the Trust’s response to this issue. The Trust has apologised for Miss E’s poor experience at the hospital, and it has shared feedback with staff to prevent similar incidents from happening again.
35. We consider the response from the Trust is in line with the Complaint Standards mentioned above. It acknowledged it made mistakes, and it was accountable for them. It apologised to Miss E for the distress its actions had caused, and it identified learning and set out actions taken to improve services.
Staples
36. Miss E complains a staple was left in her stomach which resulted in an infection.
37. The GMC guidelines say doctors should provide effective treatments based on the best available evidence. Our surgical adviser has said that there are no specific guidelines relating to removing staples after surgery, and the timing for removal is determined by the operating surgeon. They confirmed that staples can be missed, such as when they are covered with scab tissue. Our surgical adviser has said that this would not usually cause an increased risk of infection, and there would be no detriment to leaving a staple in longer.
38. The Trust’s advice states that if a patient thinks their wound could be infected they should contact their GP for advice. It also lists signs of infection to look out for.
39. It is unfortunate that Miss E developed an infection in her wound, and we can understand why she thinks this was due to a failing by the Trust. She sought advice from her GP as she felt pain and nausea, which is what the Trust advised to do. Her GP removed the staple and provided antibiotics.
40. We have not seen an indication of a failing in the Trust’s actions. We understand that developing an infection after surgery, and finding a staple left in the wound would case her distress, and physical pain. We are sorry to hear about Miss E’s experience.