Monday, 11 February 2013

Liverpool Care Pathway - The Morphine Killers

This is not the mean streets; this is the mean wards.

This is intollerable. This is a disaster.

Monday 11 February 2013

Anger at ERI over failures before OAP’s death
Thomas Notman died at the ERI
Thomas Notman died at the ERI
THE family of an ex-miner who they claim was left in his hospital bed without water for 36 hours and died while “vomiting and retching” after being pumped full of morphine have hit out at care standards at the Capital’s flagship hospital.
Maree and Stuart Notman, whose father Thomas was admitted to the Royal Infirmary after falling at his home in Loanhead, took their complaint to the Scottish Government Ombudsman.
The Ombudsman upheld almost all of the family’s complaints and said “serious failures” had been uncovered, including insufficient nursing, chaotic note-taking and a lack of involvement of the lead consultant in the 81-year-old’s care.
The family were also not told that Mr Notman – who worked at Monktonhall mine in Midlothian and was known as Troot due to his love of fishing – was the subject of a “do not resuscitate order”.
NHS Lothian has been ordered to apologise to Mr Notman’s family following the investigation and a string of recommendations have been made to the health board.
But his daughter Maree, 48, and son Stuart, 46, who were at their father’s side for much of his two-week hospital stay, say the failings their father was subjected to, before his “torturous” death, will live with them for the rest of their lives.
“We just wanted them to say sorry and we don’t want someone else or their family to go through what we went through,” Maree said. “My dad was a good citizen. He went down the pit, did his national service and never had so much as a parking ticket in his life. But it doesn’t matter what you’ve done – no-one deserves a passing like that.”
The family’s near two-year ordeal began in February 2011, when Mr Notman, who was also a keen bowler, fell, causing injuries to his hand and head. After waiting an hour for an ambulance, he was taken to the ERI’s accident and emergency department.
Although his level of consciousness was initially normal, his condition deteriorated rapidly and a CT scan – performed more than seven hours after he arrived – revealed a bleed on the brain.
Surgeons said Mr Notman’s condition and medical history meant he was not suitable for surgery, and the family were told that his condition was terminal.
He was transferred to a single room in Ward 207, which was out of sight of the nurses’ station. Despite his prognosis, the family say he was left dehydrated, ignored by nurses and was left to lie for hours in his own urine.
Stuart said: “No-one could see him. The machines were behind a curtain, we were pulling them back so that the nurses would see him through the window, but we would come back and they would be closed again. Bearing in mind that he was on his last legs you would have thought they would have kept more of an eye on him.”
When they returned the next day, they said they found their father severely dehydrated, with an intravenous drip disconnected.
“He was begging for water,” Stuart said. “But he was nil-by-mouth so we couldn’t do anything. We don’t think he’d had any water for a day-and-a-half.”
Maree added: “He had obviously not been attended to. He was hanging out of the bed and hadn’t had the catheter fitted.
“Everyone deserves basic dignity.”
Maree said that throughout her father’s time in hospital, his buzzer would be left out of his reach. When they rang it after visiting and finding him dehydrated, they say a volunteer tea lady and not a nurse was first to respond after a wait of five minutes.
After they raised concerns about the care, Mr Notman was moved to a four-bay ward, but caught MRSA and had to be sent back to the single room.
The family say they continued to be unimpressed by the standards at the hospital, which they said appeared understaffed and lacked resources. His care was left in the hands of a junior doctor, who the family say struggled to communicate with them, while the lead consultant responsible for his care did not review his patient once in a ten-day period.
A swallow test was carried out on March 5, resulting in Mr Notman being allowed pureed food and drink, although the decision was reversed two days later after he became more ill.
Mr Notman was then injected with morphine directly into his stomach with no anti-sickness medication, which his family believe led to the “torture” he suffered as he died, despite him not appearing to be in any pain or discomfort before he was given the drug.
“They had this huge syringe, it scared the pants off you,” Maree said. “You kind of trust them to do the right thing, but I think our trust was misplaced.
“He was conscious and talking and wasn’t shy of telling us if he was in pain. If he was he would have been wriggling around, but there wasn’t any of that. Then it started – the colour of the vomit was dark brown. His breathing was becoming laboured and you could tell he was near the end, but then it would start again. It was a torturous passing.
“They took us twice to the relatives’ room and said we shouldn’t be watching it, we were terrified of going back in. The death of a family member is never going to be a happy memory, but it should be something you look back on as a peaceful moment. But that was taken away from us.”
Maree said she was told by nursing staff, who were close to tears while looking after Mr Notman in his final hours, that sickness bowls and gowns on the ward had run out.
The family firmly believe that the morphine led to the violent and distressing vomiting that Mr Notman endured until his death – although NHS Lothian nurses believed he was emitting fluid from his lungs.
Stuart added: “He couldn’t move, he just started being sick, it was horrible. He would go quiet, then it would start again. We were in there nearly 24-7 for two weeks, but right at the end we had to leave, we just couldn’t stand it.”
They later found out that their dad had been placed on the Liverpool Care Pathway – which is designed to ensure dying patients are comfortable, but can see drugs administered and nutrition withdrawn, and has been branded a form of euthanasia in some quarters.
“There has to be some serious investigation around it,” said Maree. “I don’t think it’s fit for purpose.”
Mr Notman died on March 11, 2011, after he developed pneumonia.
After writing to then Health Minister Nicola Sturgeon, the complaint was forwarded to NHS Lothian, but the Notmans were left dissatisfied with the response.
The Ombudsman said that while he found the “overall level of care and treatment was reasonable”, there were some “specific issues that concerned us and we considered these to be serious failings”.
He said he was “disappointed” with care when Mr Notman was initially placed in the single room, and that it was “concerning that a patient could be overlooked due to the location on the ward”.
Among the six recommendation made to NHS Lothian were that comments over sickness medication in syringe drivers were passed on to clinical staff, and that staff are reminded of the need to discuss “do not resuscitate” decisions with patients and their families.
Melanie Hornett, NHS Lothian’s nurse director, publicly repeated an apology that the health board had already made to the Notmans in writing. She added: “We accept the Ombudsman’s recommendations in full and have taken affirmative action on all of the points highlighted in the report.
“Following a successful pilot and subsequent feedback, a new initiative has been implemented across all patient areas with the aim of supporting nursing on wards. This has had a positive impact on the organisation and documentation of the care we provide.
“Adding to this, we have reviewed the level of involvement of senior clinical staff in patient treatment and have reminded staff of the need to discuss ‘do not resuscitate’ decisions with patients and their families.”
Criticisms of Thomas Notman’s care
THE Ombudsman criticised several aspects of Mr Notman’s care, including a lack of involvement of the lead clinician, the fact that a “do not resuscitate” order had not been counter-signed by the consultant or discussed with the family, and found omissions and a lack of clarity in some notes, including no record of intravenous fluids being given on the day of admission.
The six recommendations that he made to NHS Lothian were:
• Draw comments in the report on the use of anti-sickness medication in syringe drivers to the attention of clinical staff.
• Provide the Ombudsman with details of the outcome of a “care round” trial, which was aimed to improve person-centred care, and any changes to their patient monitoring procedures afterwards.
• Review the level of involvement of senior clinical staff in patients’ treatment.
• Remind staff of the need to discuss “do not resuscitate” decisions with patients and their families.
• Remind nursing staff of the need to maintain full and accurate nursing records in line with Nursing and Midwifery Council guidance
• Apologise to Mr Notman’s family for the issues highlighted in the investigation.
Single room plan controversial
SINGLE room wards are being rolled out across Scottish hospitals.
At the new Royal Victoria Building, based at the Western General Hospital, every one of the 147 beds are based in single rooms.
The new Sick Kids Hospital, to be built next to the Royal Infirmary, will boast 59 per cent of beds in single rooms.
And the Department of Clinical Neurosciences and Child and Adolescent Mental Health departments, which will be on the same site, will offer all inpatients single rooms.
Both facilities are due to open in 2017.
It is argued that the move will increase dignity for patients, allow them a more peaceful environment and help reduce the spread of superbugs.
But the Scottish Government policy has proved controversial, with some arguing it could lead to some patients becoming isolated or being forgotten about.
The Notmans were horrified to learn of the move following media coverage of the Royal Victoria Building’s official opening last week, after the experience of their father in a single room at the Royal Infirmary.
Stuart said: “They didn’t even used to look in at him as they were passing. He was just left at the end of the ward.
“There’s better care if they’re in a ward, it’s easier.”
Maree added: “A nurse told us, ‘They’re often forgotten about when they’re in a single room’.
“When they told us he was being put back in the single room [after contracting MRSA] our initial thoughts were ‘oh my God’.”

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