"Lack of information and concerns over informed consent"

My partner had surgery in the NHS Fife day surgery unit at Queen Margaret hospital earlier this week. The staff on reception were great and very helpful all day while I was waiting and very friendly. She also said that the anaesthetist was very helpful and took time to explain things to her and answer her questions.

However there are several issues about yesterday which are a cause of concern that I wanted to draw attention to. I have had six surgeries in NHS Lothian, some planned, some emergency and a mix of inpatient and day procedures and every single time I have been able to have a relative/partner sit with me on the ward (in a bay with other patients) until I went to theatre and again once I was back from recovery.

I was very taken aback that this wasn't allowed in the Day Unit and it seemed to be extremely counter to the posters everywhere declaring that the ward was prioritising 'person centred care', for two specific reasons:

Firstly, my partner was extremely nervous about the surgery (which I told the staff), as it was her first hospital experience, surgery and general anaesthetic all in one and wanted me to be there to help her ask all the questions she wanted to ask the surgeon (which didn't happen) and secondly because, as I know well from my own experience, a patient who has had general, even once they have come back from recovery, is not remotely fully competent to be told and remember information about their surgery result, wound care requirements or anything else.

This meant that my partner left the hospital confused and unclear on what exactly she had been told post op, and recounted several concerning things to me - such as being told two different things by a doctor about showering and changing her dressing and not knowing which was the correct one, and not being able to get nurses' attention due to them standing talking about TV, and the doctor walking away from her whilst finishing the post op update so that she had to wave and raise her voice to get the doctor to come back so she could ask a question. No-one asked how she was feeling when she woke up, and she has no idea if the surgery was able to remove all the lump or if anything else happened.

I was however most concerned to hear that she wasn't even aware she had been consented for the surgery, and had no idea what I was talking about until I asked if she'd signed anything. She answered that she had but when she had asked if she needed to read or tick the boxes on the sheet she was told she didn't need to, and to 'just sign at the bottom' - this is obviously completely unacceptable and also means that she has no idea of what she consented to or of the potential risks and side effects of the surgery or what to expect post op.  For example, is numbness expected in the area? Will this go away? For a patient to be unaware that they have signed a consent form and not to have risks explained to them is deeply unsatisfactory.

She also had a fairly significant rash all over the side of her body which after consulting a surgeon I know, seems to be a reaction to the chlorahexadine pre agent or similar (which is obviously unavoidable), but she was given no information about this in hospital and was just told that it 'was from the drape' and unusual, which was not useful to a lay person and as a result she was worried and confused about that too, and particularly about if and when it would go away (and was still present 2 days later).

She was also told by a doctor that she could take her dressing off in two days, and then when I called the next day was told that she definitely shouldn't take it off before her clinic follow up apt in two weeks.

The surgeon also told her she could go back to work the day after surgery, without asking what her job is, which involves heavy lifting and going up and down ladders.

This was frustrating as I had repeatedly asked (upon arrival and during the day) that the discharge letter specifically mention how long my partner needs to wait before climbing ladders as it is a daily part of her job description and her boss will require a note to excuse her from it. When the letter didn't have any mention of this I followed up with a nurse and I was told that a message would be given to the doctor. I didn't have a huge amount of confidence that would be the case so it was another issue I asked about when I called for clarifying details the next morning. Contrary to what the surgeon had dismissively said to my partner I was told that she should wait til after her clinic appointment to do any heavy lifting or ladder climbing. I have since called the surgeon's secretary to request that a letter detailing this be sent to her medical unit - which will be a delay I had hoped to avoid by asking for the information to be in the discharge letter. 

That was the only other question that was answered when I called the ward and was told that they couldn't help with anything else and that I would need to call numerous other people/departments (but they couldn’t tell me numbers) to find out the answers to the rest of my questions - which is fine, except not something that a lot of people would have the confidence to do.

All of these issues could have been prevented and/or solved had I been able to sit at her bedside to hear the post op update from the surgeons and everything else she needs to know, as I had expected, as well as to be an advocate for her during the whole process.

We are lucky that I have had so many surgeries and general anaesthetics and so was able to give her some idea of what would happen during and after and how she might feel during recovery - however most people do not have so much knowledge or experience. 

It's obviously too late for my partner, but I think patient experience in the unit could be significantly improved if patients either could have a partner/relative at their bedside on the ward as it is in NHS Lothian day unit, or at the least, if the person who picks the patient up from surgery is given a full update as to how the surgery went and what care is needed and what rest is required etc from one of the nurses - I had to ask to speak to a nurse specifically as I was given no information and within two minutes of chatting with my partner in the waiting room while getting ready to go it was clear she wasn't clear on most of the information she should have. The nurse didn't have the information I asked about and said a doctor might write a letter if needed, and then the rest of these issues became clear once my partner and I got home. I witnessed two other patients being discharged and collected by their relatives during the day and none of the collecting people appeared to receive any verbal handover or care info from the person bringing the patient to the waiting room.

I'm sure you can understand why I'm so concerned about my partner's experience - particularly regarding the consent and the information given - and hope this is useful to improve things for other patients.

Thanks for your help.