"Lack of Nursing care"

About: University Hospital Monklands / General Medicine (Wards 2,10,12 and 17)

(as a service user),

I have recently had the poor experience of being a patient at Monklands under the care of medical team for a TIA. I visited my GP recently, complaining of severe head ache, visual disturbances of my left eye and numbness of my left side and balance issues. My gp instantly referred me to A and E as a matter of urgency due to high blood pressure and neurological tests completed that made him query a Stroke. My gp had telephoned down ahead of my daughter driving me to A and E and was told I would be seen immediately.

I reached Monklands A and E at 16.30 to be told to have a seat and I would be called in. My daughter who is a well experience trained nurse had advised the reception that I was to be seen immediately, so a kind nurse took me into a assessment bay to have bloods, neurological observations and standard observations done and reassurance. I completed this to be told have a seat out in the waiting room as they were waiting on bed for me in MAU. 

I had advised I was unsteady on my feet and feeling dizzy at this point to which I had to take my daughters arm. I then waited in severe pain again and yet I hadn’t been seen by a medical professional at this point.

I proceeded to wait another 4 hours with my daughter and wife in a waiting room in pain, I had asked for pain relief and nurse had prescribed painkillers  to which it had no effect.

After these 4 hours passed I had been took into MAU ward around the corner from main a and e department, I walked and was unsteady on my feet and my daughter had to help me as I had to walk from waiting room to this ward. I proceeded to the nurses station and I was greeted by a lovely friendly nurse who placed me into a room and advised that a member of staff would be back to clean up the mess in the room, as previous patient had just left. The room was totally disgusting, the last patients sputum sample was still lying on the table, the bed hadn’t been changed and a dirty nebuliser mask was still sitting next patient locker. I therefore couldn’t lie down and was even more uncomfortable left sitting in a small chair. We had to ask a hour later if the room could be cleaned. I then waited another 4 hours whilst my daughter noted that no member of staff had been to do any kind of observations since my first admittance into a and e (16.46pm).  She flagged up several times and how much I was in pain and would the doctor be much longer. A nurse came in and handed me two paracetamol with no water to take my tablets with so my daughter had to give me her water. Two hours later (now midnight) I am still waiting on the doctor to see me, baring in mind my GP referred me urgently due to concern of a stroke. 

I was then advised by a member of staff that due to previously being administered paracetamol I needed to wait which is understandable. My daughter had advised that it was unacceptable that a patient who is potentially having a stroke hasn’t had any neurological observations or even a blood pressure completed as this was raised earlier and that she knew that SIGN Guidelines states that patients with potential diagnosed/undiagnosed with TIA’s must be treated with anti-thrombosis/thrombosis within 60-90 minutes from admission and have hourly observations carried out, the nurse had looked at my charts puzzled as someone had documented that they had been in at 21.00pm.  No member of staff had been in but on my notes the time and signature had been documented that someone had been in. 

The nurse was appalled at this and immediately had asked the staff on duty what had happened. 

At 1am in the morning after my daughter stating she was a trained experienced nurse and that no observations had taken place or admittance had taken place in MAU eventually seen doctor, who had advised I needed a CT scan which I went for around 2am. From there I got transferred to another ward called AMRU whose care was outstanding, the nurses and Drs care was very patient centred care. They helped in every way they could possibly and reassured me and also spoke with great detail of what had happened. I have now been diagnosed through my CT scan as having a mini tia. 

The outcome of my hospital visit was appalling, the lack of nursing care and patient centre care from ward MAU is totally unacceptable and in my opinion verged on patient neglect.  I believe nurses have a duty of care to patients to treat them with kindness, respect and compassion, to which my care wasn’t. It was a neglect of basic nursing care. 

To go 7.5/8 hours without any observations or effective pain relief is inhumane and incompetent. The only positive experience I had in that ward was with one member of staff who was lovely and very understandable and pro patient care.   This member of staff reassured me and also took over my care others.  This member of staff went above and beyond nursing standards and maintained their professional practice and compassion for their patients. To this person I say thank you. 

I fear that if I was on my own and compromised I may not have had an advocate in my care. The whole center surrounding nursing care is that a nurse will be the patients advocate, to put the interest of the patients safety and to make sure their dignity is preserved. Both my dignity and my faith in nursing care has been tainted by this whole experience. 

Responses

Response from Karen Goudie, Chief Nurse, University Hospital Monklands, NHS Lanarkshire 12 months ago
We are preparing to make a change
Karen Goudie
Chief Nurse, University Hospital Monklands,
NHS Lanarkshire
Submitted on 27/09/2019 at 14:38
Published on Care Opinion at 15:05


picture of Karen Goudie

Dear Orangetg53,


I was very upset and concerned to read about your experience in our hospital. What you and your daughter experienced is unacceptable and far from the standard of care we would expect from our teams. I am hopeful that we can meet to discuss your experience in detail so that we can learn and act. I apologise on behalf of UHM and the team involved in your care. I sincerely hope that your health has improved and that you are feeling better. If I can be of any assistance at all please do not hesitate to contact me prior to a potential meeting date.

Kindest Regards,

Karen

01236748748 Ext 3306

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Response from Gavin Dolan, Senior Nurse, Emergency Care Directorate, University Hospital Monklands, NHS Lanarkshire 3 months ago
We have made a change
Gavin Dolan
Senior Nurse, Emergency Care Directorate, University Hospital Monklands,
NHS Lanarkshire
Submitted on 13/06/2020 at 15:20
Published on Care Opinion on 15/06/2020 at 13:14


picture of Gavin Dolan

Dear Orangetg53,

I am sorry it has taken so long to reply to you in terms of the changes that we said we were going to make after receiving your feedback via the Care Opinion platform. Firstly, let me offer you my sincere personal apologies for the clear lack of care and professionalism and for what read as a horrendous experience for both you and for your daughter. You must have felt really let down by us and I can understand why your daughter was so annoyed with the unacceptable time you had to wait to see a clinician. I wanted to let you know some of the things that my teams and I have changed in terms of ensuring that this incident never happens again since you left feedback some months ago.

Your comments were shared widely (for the purposes of learning and changing practice) with the teams in both the Emergency Department and within the Medical Assessment Unit (MAU). We used your feedback at our newly designed morning safety huddles and discussed various scenarios in which patients would present to the units and how we would recognise physiological decline in unwell patients. We discussed communication and assessment and also discussed how we assess and manage acute pain. We also spoke at length around initial observations and neurological decline and the importance of neurological observations and from this, decided that we would ensure that all patients who presented to the department / unit were started on a specific neurological assessment chart incorporating early warning scoring (a very succinct way of measuring decline in physiological health which should prompt a clinical response). This is now very much embedded into our every day practice and I can confidently say that as a result of your feedback, we have changed our process in this for the better.

I was very sorry to learn that your GP had informed you that you would be seen by the medical team immediately on arrival to the Emergency Department. Sometimes, the information and language used with patients can be misleading. Our hospital is a very busy receiving district general hospital which serves a vast part of the north of Lanarkshire. What your GP maybe should have said was that he was referring you to the receiving medical team for an urgency medical opinion and further investigation. Within the Emergency Department at University Hospital Monklands, we do an initial assessment of all GP referred patients before arranging to move the patient into the MAU to see one of our receiving clinicians. The reason for this is to immediately identify any life threatening issues and to ensure that any immediate interventions are carried out timeously if required. It was very hard to understand if this was a particularly busy day or not however, I want to stress that this should in no way, detract from the fact that I believe from your story that you have an unacceptably long wait to see a clinician which in my opinion is not good enough. For that, I am very sorry for the stress and anxiety this has caused. I wanted to let you know that I continue to work hard with my patient flow colleagues, clinician colleagues, consultant colleagues and improvement colleagues to ensure that our GP pathways are robust and very patient centred. At the time of your admission, it was clear that these pathways let you down quite considerably. As a result of this, we have developed an Unscheduled Care Improvement group that is constantly reviewing and looking at all aspects of referral to hospital specialists and we are making some very positive progress around the way in which we care for and look after our patients both in a holistic and in a timely fashion. Again, I am confident that your story has helped us realise that our processes needed to be changed.

Finally, I wanted to let you know that the Senior Charge Nurses within both the Emergency Department and the Medical Assessment Unit are both proactively looking at staff training and education and as a result, have developed an ongoing professional development programme for our staff working within these high care areas. I believe that communication is paramount in any walk of life and the impact of words, body language and expressions can last a lifetime. We are working hard to ensure our staff appreciate the significance and importance of patient centred care and how they deliver quality and compassionate care whilst ensuring that they remain highly skilled in their fields. I am satisfied that the staff have embraced these concepts fully and will continue to learn, grow and develop their skills in all of these areas. The lack of communication, empathy and compassion you appeared to have received from your post has really made us all stop and revaluate how we deliver care and how we engage with patients and the public. The level of care and compassion that you received shouldn't have been any different in AMRU than in MAU or ED and we continue to ensure that that same level of care is applicable throughout our whole organisation.

I am truly sorry once again for your experiences within our hospital and would hope that you will see that we really do take all feedback seriously. Your feedback has really made us stop and reflect and change our practices and for that I thank you very much for being so honest in your feedback. I hope that you can have some peace in the fact that we will ensure that this type of experience will never happen again and I would hope that I have tried to give you some reassurance once again in the NHS, in particular, University Hospital Monklands. I very much hope that your are recovering well now and wish you the very best of health for the future.

Best wishes,

Gavin

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