15. 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 seriously wrong.
Schedule of visits
16. Mr Y told us the Trust agreed he would be visited between 10am and 10.30am but this timing was not always followed. When timings were not followed, he raised this with the nurses visiting him.
17. In its complaint response, the Trust explained specific timings cannot be guaranteed except where clinically or medically essential, but it would try to accommodate a window of delivery.
18. We have considered Mr Y’s medical record to look further into what happened.
19. On 10 January, Mr Y requested appointments be made at around 10.30am if possible. Between 11 and 22 January, Mr Y was visited 12 times. These visits were made between 8.30am and 4.44pm with nine visits completed by 10.30am.
20. On 22 and 24 January, Mr Y raised his frustration with the inconsistent timing of visits saying he should be visited at 10.30am. The nursing team explained there was a two hour window to administer his injection. Between 23 January and 20 March, Mr Y was visited 42 times. All but seven visits were between 10am and 10.30am.
21. NHSE guidance on response times explains the only response target applicable within the community is a two hour response time for those who urgently need care. Our adviser explained this does not apply to routine injections such as tinzaparin. They explained it would not be expected nurses could agree to a guaranteed 30 minute window on a regular basis. This is because nurses have a high caseload of patients, typically ten to 20 a day with increasingly complex needs. It would not be feasible to expect a 30 minute delivery window within that workload.
22. We acknowledge Mr Y feels his visits were inconsistent. We can see there was an element of inconsistency in his earlier visits but this improved after he raised his frustrations.
23. We have not identified any guidance that says nurses had an obligation to provide care within a 30 minute window. Despite this, overall the Trust did provide the vast majority of visits being within a 30 minute time window.
24. Due to this, we have seen no signs the Trust failed to act within the relevant guidance. For this reason we have decided not to consider this part of the complaint any further.
Cleaning skin prior to injection
25. Mr Y has raised concerned his skin was not cleaned before the Trust administered injections. Mr Y told us he was concerned this was not good practice.
26. The Trust said in this situation a nurse would only clean a patient’s skin if it is visibly dirty.
27. The green book sets out guidance on administering injections. Specifically its says:
‘If the skin is clean, no further cleaning is necessary. Only visibly dirty skin needs to be washed with soap and water. It is not necessary to disinfect the skin.’
28. Our adviser explained all nurses should be familiar with this guidance.
29. Taking account of the guidance, advice and noting Mr Y does not report his skin was dirty, we are satisfied the Trust’s actions are in line with national guidance. For this reason we have decided not to consider this part of the complaint any further.
Failing to cover injection site
30. Mr Y has told us on occasions, after the Trust administered his injection, liquid leaked from the injection site, and nurses did not adequately clean this. Mr Y told us this was distressing to experience.
31. Mr Y’s medical records show there are occasions where the Trust left him with gauze and skin wipes. We have also seen two recorded instances of the injection site being cleaned with a wipe after administration. There is no reference to liquid leaking from the injection site. Mr Y could not recall exact times this happened.
32. NMC Code say patients receiving care must be kept in clean and hygienic conditions.
33. In its response, the Trust advised any leaking should be dealt with by the nursing team when the situation arises. It also stated it would remind staff to take extra care when administering injections. It also apologised for Mr Y’s experience.
34. Considering the guidance, we are satisfied the Trust’s expectation leaking is dealt with by nurses is in keeping with NMC Code. As there are occasions Mr Y was left with gauze and skin wipes it is our view it is more likely than not this did not always happen. We appreciate this was distressing for Mr Y.
35. In our complaint standards, we set out our expectations on Trusts and their handling of complaints. This includes Trusts recognising the need to be accountable for their actions and identify what learning can be taken from a complaint.
36. We are satisfied the Trust has taken appropriate action in keeping with our standards by speaking with staff to address the issue Mr Y raised and in apologising to Mr Y for its impact.
37. For this reason we have decided not to consider this part of the complaint any further.
Not acting on GP’s email
38. On 8 February, Mr Y contacted his GP asking them to let the nursing team know he will not be available from 15 February for two weeks as he would be travelling.
39. Mr Y’s GP sent the Trust a task via internal communication stating:
‘Mr Y is under your care, he informs me that on some days he will be having an operation, please can you contact him to discuss the days you can visit?’
40. The Trust received the task on 11 February and closed it on 14 February. There is no information that specifically explains why the task was closed, however Mr Y’s records say he had discussed his availability with nursing staff on 13 and 14 February. In these discussions he had asked for an earlier visit from the Trust on 15 February. We have seen no sign Mr Y raised his planned unavailability with the Trust during these discussions.
41. NMC Code says nurses should work cooperatively with colleagues and listen to people’s preferences regarding their care.
42. Based on the information the Trust received from Mr Y and from his GP, we are satisfied it believed it has contacted Mr Y to discuss his availability as per the GP’s communication and it had listened to Mr Y’s preferences around his appointment times.
43. For this reason, we cannot see the Trust could have reasonably known Mr Y was away when he did not answer his door or phone in the following days. We recognise the information Mr Y says he gave to his GP, was not the same information the GP gave to the Trust and this will likely be very frustrating for Mr Y. We were very sorry to hear that this led to his door being taken down. We hope this explanation helps him understand what happened and reassures him of the Trust’s actions.
44. We appreciate this was a frustrating sequence of events but we’d like to thank Mr Y for bringing this complaint to our attention.