"Post-Op care for Pacemaker patient"

About: Forth Valley Royal Hospital / Cardiology Forth Valley Royal Hospital Cardiology FK5 4WR General practices in Lothian General practices in Lothian Edinburgh EH16 4SA Royal Infirmary of Edinburgh at Little France / Cardiology & Coronary Care Unit Royal Infirmary of Edinburgh at Little France Cardiology & Coronary Care Unit EH16 4SA

Posted by Nickmcb (as a carer), 5 years ago

My partner had a prompt and much-needed pacemaker implant on her birthday after a series of blackouts - which were initially diagnosed as Epilepsy until extremely low BP and BPM were spotted during another episode.
A late-night Emergency ambulance transfer from Forth Valley Royal Resuscitation unit took place after midnight that day, with a Cardiac team on board, to Edinburgh Royal where the pacemaker was installed within 24 hours. Appointments were made for a 4-week follow-up and local support from Meadowbank GPs near home. All OK so far.
That's when the Birthday Present became a bit of a nightmare. We had a number of difficulties getting post-op support and maintenance at the Forth Valley Royal hospital, in getting through to the local GP surgery for check-ups.
Currently we have been trying for over 48 hours to get any response whatever from the Forth Valley Royal Pacemaker Care number for a partially open operation wound which we feel poses a considerable risk to the patient. We're still waiting
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Catherine Labinjoh

Consultant Cardiologist & Clinical Lead for Cardiology, Cardiology,

NHS Forth Valley

Hospital doctor, specialising in Heart Disease

Submitted on 12/11/2018 at 16:27

Published on Care Opinion at 21:00

Dear Nickmcb
I was very sorry to read your post on Care Opinion today and I am concerned by what you have written. It sounds as though we need to see your partner fairly soon. If you get this message in time, please ask her to come to the cardiology outpatient department on the first floor of Forth Valley Royal Hospital tomorrow, ideally between 8am and 12 noon, and I will see her personally. Just ask for me at outpatient reception. If this arrangement doesn't suit, call my secretary Sharon and she will arrange something at your convenience - 01324 566832.
I don't want you to worry - but if your partner feels unwell in the meantime she should seek urgent attention from your GP in hours or NHS 24 out of hours - but I know that's been difficult so far. From what you say I don't think attending the Accident and Emergency dept is going to be needed overnight but it's there if you have serious concerns.
Once again please accept my apologies for your difficulties. I hope to see you both tomorrow.
Catherine

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Sara Ross

Senior Charge Nurse, Cardiology,

Royal Infirmary of Edinburgh, NHS Lothian

Submitted on 12/11/2018 at 16:53

Published on Care Opinion at 21:01

Dear Nickmcb,
Thank you for taking the time to get in touch to let us know about your partner's experience.
I was pleased to hear that you were transferred very promptly from Forth Valley Royal and treated very quickly here at the RIE.
I am slightly concerned though, that your partner has a partially open pacemaker wound, as both of you must be too.
It would seem from your feedback that you have tried to contact the pacemaker department in Forth Valley Royal over the last 2 days when unfortunately they would have been closed as this is a Monday to Friday service. Please try again. I have spoken to the pacemaker department here at the RIE and they have given me the number of Forth Valley Pacemaker department to ensure you have the correct number which is 01324 567231.
If you are worried about the wound, and unable to contact the pacemaker department then you should contact your GP/practice nurse and ask for an urgent appointment to assess the wound.
If I can help in any way please do not hesitate to contact me in ward 103 at RIE on 0131 242 1031.
Best wishes
Sara

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Catherine Labinjoh

Consultant Cardiologist & Clinical Lead for Cardiology, Cardiology,

NHS Forth Valley

Hospital doctor, specialising in Heart Disease

Submitted on 13/11/2018 at 16:10

Published on Care Opinion at 19:59

Dear Nickmcb
I was really pleased to meet with you and your partner today. You have both been through such a lot and were struggling to find the support you needed. I am really sorry about that and for the confusion around where to go for advice - not helped by us taking down the wrong phone number and struggling to get in touch with you after you rang. I have spoken with the team who would like to express their sincere apologies for this.
We agreed that we could work to improve the advice given to Forth Valley patients undergoing pacemaker procedures in Lothian. We have already started work on this and look forward to updating you on this improvement. We also agreed that although the telephone number you were given was an administrative one, and not a source for advice about urgent health matters, it would be better if we used answerphones less and increased the opportunity to have a conversation with a person when you call. I am not sure how easy it will be to do this but I will speak with my admin support manager.
Thanks again for taking the time to give feedback. I was pleased to see that your partner has been receiving good attention to her wound from the practice nurse and was happy to be able to offer reassurance today. We look forward to seeing your partner at the next check up.
With best wishes
Catherine

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Update posted by Nickmcb (a carer) 5 years ago

Excellent, very helpful responses above and we met productively with Dr Labinjoh today re all the content below.
Often the most skilled and experienced team can be let down by apparently minor and inexpensive links in the system. E.g. something not quite right in Paperwork, not linked in backroom staff, a missing connection between neighbouring processes. These were called 'moments of Truth' in my work career as a process and business consultant, and can blow the careful, committed and diligent efforts of the most admirable teams right out of the water. Here, it was joining-up of post-op care incl. documentation between the excellent emergency facility at Edinburgh, and the in-place team equally professional, at Falkirk. And that Phone Line ..
All of these millions invested on the medical side, and such good and dedicated clinicians ... and what went wrong amounted to tiny items:
1 RIE discharge documentation that states that the first point of contact if concerned with the pacemaker or wound recovery would be the local hospital's Cardiology / Pacemaker department.
Makes sense, doesn't it? Seemed to work locally, especially when the FRVH phone line calls itself the Cardiac and Pacemaker Support line.
2 Not the case however. In Falkirk District the post-op care is split between local GP services for wound care, and the Hospital for Pacemaker / Cardiac rhythm issues. How were we to know this?
3 FVRH Cardiac and Pacemaker Support phone line is a 10 - 3 weekday line staffed by clericals not clinical staff, and not designed to field medical queries. We didn't know this either.
4 The clerical worker fielding our calls couldn't apparently call us back at the correct number despite us leaving it twice each time we called, along with patient name and DOB as requested on the message, last Weds / Thurs and Fri. She couldn't have been more helpful yesterday, Monday however.
4 Should the recording have missed our number six times, surely anyone could have heard the patient details also given and looked up / cross-checked our contact details on the multi-million FVRH £ computer system?!
For a Ha'porth of Tar. And, frustrating the otherwise admirable and successful efforts of both hospitals. Service Gap Analysis well worth carrying out, IMHO

Catherine Labinjoh

Consultant Cardiologist & Clinical Lead for Cardiology, Cardiology,

NHS Forth Valley

Hospital doctor, specialising in Heart Disease

Submitted on 14/11/2018 at 13:34

Published on Care Opinion at 14:36

Thank you. I'll take some time to reflect on all you have said especially your "moments of truth". We really appreciate your feedback and I'll share your further observation with the team.
Best wishes
Catherine

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Update posted by Nickmcb (a carer) 5 years ago

Excellent response and many thanks

Catherine Labinjoh

Consultant Cardiologist & Clinical Lead for Cardiology, Cardiology,

NHS Forth Valley

Hospital doctor, specialising in Heart Disease

Submitted on 28/10/2020 at 11:57

Published on Care Opinion at 14:44

Dear Nickmcb,
It's almost two years since you were good enough to take the time to feedback to us about your partner's experience of the pacemaker service here and in NHS Lothian. You made some really useful observations and I am writing to let you know how we are getting on with the changes I said we'd undertake.
We did make some improvements to our process and patient advice leaflets to tackle the communication gap your noted. However, we recognised that a major part of our difficulty was delivering a service for Forth Valley patients outside of Forth Valley. We always wanted to deliver this more locally and I am pleased to say we have made huge strides towards this. We now implant more than 90% of pacemakers and cardiac devices in Forth Valley Royal Hospital which makes things much smoother for everyone.
We are still challenged a bit by how we enable patients to access advice, exactly how and when they'd like to. This is especially difficult at the present time due to our challenges with Covid-19 but it's not all gloomy. We have enabled much more remote monitoring from home for pacemaker patients and we're better at phone calls and video calls than we have ever been! The dreaded answer machine is still part of our process though following staff training we are much more rigorous about how this is used. We are still reliant on services from your family doctor team around wound care and dressings and generally that works really well.
I hope you are both well and managing to make the best of these difficult times.
Thanks again for your feedback which helped us develop a much better service for Forth Valley patients.
Best wishes
Catherine

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