"The Loss of Basic Nursing Care"

My step-father of 87 yrs was admitted to UHW following a fall at home, sustaining a fractured neck of femur. He remained in the ambulance for approximately four hours before getting into A&E, he then remained on an A&E trolley for a further 24 hrs before a bed was found in Ward 12. Due to the fracture he was not moved during this time, his pressure areas were never checked and therefore pressure damage had already begun. No one checked if/when he had last passed urine, when I was allowed into A&E I highlighted to staff that he had not passed urine since admission, they arranged a bladder scan and he was then catheterised.

Once in the ward he was placed on a pressure relieving Repose mattress. Surgery was delayed for four days due to respiratory complications. Communication from the doctors and anaesthetist was good, discussing his condition and treatment options. We were advised there was a narrow window when surgery may be possible, but they would keep him under review. Unable to mobilise, he was unable to maintain his own personal care, we would visit twice daily and without fail would have to clean his dentures and assist him to shave, basic components of daily hygiene most would value.

On one occasion we arrived in the ward following lunchtime and he did not have any dentures in, he had been given his breakfast and lunch without any assistance to get his dentures from the night cup. We arrived for visiting on the fourth afternoon to be told he was not in the Ward but had gone for his surgery that a.m., despite calling the Ward that a.m. to enquire how he was, we were not told surgery was scheduled. The following day at afternoon visiting I noticed he did not have in his bottom dentures, asked staff who were unaware, they were now lost. Asked them to refer to the Community Dentist to arrange a replacement as quickly as possible as to recover he needed to optimise his nutritional intake. Staff stated they did not think they were covered by this service but would ensure a claim would be sent to the Estates Department that we could pursue.

I telephoned the Community Dentist in Coatbridge myself who said the ward should refer him. I provided the ward with the contact telephone number and they made the referral. We highlighted to the ward that we wished him to be discharged home to the care of his family ASAP, they put me in contact with a Physiotherapist in the Ward who took all the details about his home adaptations, what we would need, and any changes to his social work package and got the ball rolling. I was then contacted by the hospital Social Worker and again she was very helpful in getting the discharge plan moving.

Staff then informed me they planned to remove his catheter the next a.m., at which point he was still immobile, I explained he had a urology history which would not be in his NHS file as had been seen privately this year due to lengthy NHS waiting list. I stressed the catheter was inserted due to retention and prior to admission he was unable to use a urinal, getting up 3-4 times a night to pass urine, they discussed with the Doctor and agreed the catheter could remain in.

We were not advised he had pressure sores, I could see from his underwear that this must be the case and then asked staff, who confirmed he had a sacral sore though their Ward Notice Board stating 0 Pressure Sores never changed. He was then transferred to Ward 12 with a planned discharge date in one week. Again, staff advised they would remove his catheter prior to discharge, when I highlighted the previous discussion, the Charge Nurse who took the hand over from Ward 12 advised none of this information had been passed on. I am fully aware catheters carry infection risks but at this time, whilst immobile, it was  the best option to avoid further urinary retention and falls risk. I did visit one evening to find him sitting at the bedside with the catheter leg bag lying on the ward floor, on checking his locker I found the catheter leg strap in the drawer.

On the day of discharge the outside temperature was 4 degrees, we had brought in his housecoat, scarf and hat. As immobile and multiple stairs to the home, hospital transport was necessary. He arrived home in his pyjama top and bottoms, his housecoat, scarf, hat remained in his one carrier bag of belongings, he didn't even have a hospital blanket around him. Had no one in the Departure Lounge thought to ensure he was sufficiently dressed?