"Poor Care and Unsafe Discharge"

My father was admitted via ED to Ward 5C at Raigmore hospital, the following issues occurred:

It's disappointing when a nurse makes disparaging comments about their colleagues who had been looking after my father, they were very vocal in stating that they should have had him up in a chair not on his bed so that he could be weaned off the oxygen. They obviously weren't happy with something, but telling a patient's daughter this is unprofessional. If they had valid concerns then this should have been brought to the attention of  their manager. I said that Dad would be happy to sit in the chair now but they brushed this off as it was night-time and should have been done during the day. I'm led to believe that hospital care is 24/7, therefore weaning off oxygen should be able to be done at any point not just during the day.

Staff communication was between nursing and medical staff in relation to discharge planning. I advised the Staff Nurse (SN) who was looking after my dad that if he was to be discharged over the weekend I would need notice to enable me to arrange alternative transport for him, they were unsure if it would be Sat or Sun, but was very confrontational in their manner telling me I shouldn't want my dad left in hospital if he can go home. I explained that of course I did not want him to stay in hospital but I had plans that could not be changed at short notice.

I was called at on the Saturday by a member of the medical staff who advised me to collect Dad at lunchtime. I explained I had already spoke to a nurse and explained this. I said I was unable to collect till Monday. My sister called the ward after this and as she was also unable to travel at short notice. Discharge was arranged for Monday. No one from the ward contacted me on Monday to advise of this, my dad sent a text. I called and spoke with the nurse looking after dad and they advised he would move to the Discharge Lounge in the afternoon and would call me to let me know when this happened. This did not occur. My dad informed me himself.

Failed and Unsafe Discharge:

Discharge Notification letter has no information regarding wound care and when the dressings can be removed. I had to ask the discharge lounge nurse to contact the ward, they then called me to advise as it was 5 days post-op then can be removed or left on a bit longer, it was up to me.

When I returned got Dad back home I removed the dressings and saw that the one at his bellybutton was very red, hot to touch and weeping. I contacted the GP practice, who advised me it was not their concern and to call Ward 5C, they did provide a dressing.

I called Ward 5C and spoke with an ANP who arranged for me to bring dad back to the AEC Unit for review the following day. On attending the unit, the Nurse was very concerned that this wound was infected as the redness had increased from the day before. A surgical review was required and more bloods taken. The outcome of this was to discontinue one antibiotic, continue one and start a new one. I feel that if the dressing was to be removed on day 5 then this should have been done prior to discharge and the problem treated then. They will call on Friday to review him.

Medication Issues: The discharge letter advises that the antibiotics have to be continued for 2 further days. The packet of amoxicillin states - take One Capsule Three times a day for five days . The Metronidazole states -  Take One tablet....... times a day for...... days. The relevant information has not been included on this label. While my dad is not on managed meds via a dosette box his Getting to Know Me form does state that I look after all his medication and put into boxes for him. I was disappointed the Nurse in the discharge lounge had not noticed the error when administering his lunchtime dose of medication. Had I not been looking after this for him then I dread to think the outcome, especially in times where there are issues with antibiotic resistance. 

Pressure Damage: Once again my father has pressure sores on both his ears from the Nasal Canula that he required when his oxygen levels were low. Considering this is a known area where pressure damage can occur I am disappointed that this appears to have been missed again. It is not noted on the discharge letter.

Missing personal medication and prescribing issues: I provided the ward with the correct eye medication for dad from his CMS prescription. The remainder of this was not returned on discharge, at time of writing I am waiting on the SSN calling back to advise if they have been found.

My dad also was upset that they continued to administer the eye drops at incorrect times, he stopped complaining as it didn't seem to make any difference. While the Discharge letter has the correct times, the Latanoprost continued to be given in the morning despite the label on the box stating it should be administered at night. 

DNACPR: My dad's copy of this was given to the ambulance staff and then given to the hospital on admission to the ED, however I have noted that this was not returned to him on discharge. This is an important document that he requires to have in his house should any medical/ ambulance personal attend. 

Overall this ward has not improved despite a previous complaint made after my dad's last admission in March this year. Its' clear to me that lessons have not been learnt