"My dad's care in ward 111"

My dad was admitted to ward 111 recently following a CT Scan showing fluid in his abdomen. 

He had previously been a patient in this ward in February where he was treated for sepsis and had a liver access drained. During this time he was given several antibiotics. He has a penicillin allergy diagnosed over 5 years ago during cancer treatment. 

On admission to 111 yesterday he had bloods obtained for culture and a cannula inserted. Under local anaesthetic he had a needle aspiration from his abdomen and fluid sent also for culture. With a suspected infection he was told he would be started on broad spectrum antibiotics. Unfortunately he was then prescribed and given iv pipericillintazobactum (a penicillin) During administration he felt groggy and unwell he put this down to the local anaesthetic wearing off.

It just so happened I called him on his mobile at this time for an update on how he was and the plan for his care. He said he felt terrible and the Drs suspected he had an infection so had started antibiotics. I asked him if he was on the same antibiotics as last time and if he had told them about his allergy. He told me he had made them aware during admission but nobody had come round to ask which medications he was on - and that he had been administering his own medications and insulin and nobody had been checking he was doing so which was unusual. He said he had been started on an antibiotic that the nurses called taz but was unsure what it was actually called. Being a nurse I knew that this was a penicillin and asked him now many doses he had been given. It was at this point he told me that the first dose was currently running. I told him to hang up and Buzz the nurses immediately to stop the infusion. He did so.

I spoke to him shortly after and he told me that the Dr on the ward at that time had then come in to discuss this and told him because he had not had any facial swelling or breathing difficulties in the time that it had been running that it was probably fine and they would restart this! I told him that reactions to antibiotics typically happen with the second dose and the absence of anaphylaxis was not necessarily an absence of reaction. True enough 20mins post administration he felt much better.

As my dad had then refused the restarting of the taz the decision was made to hold off any antibiotic treatment until the morning when it could be discussed with the senior team rather than starting an alternative. Nobody checked his observations overnight or checked how he was after the event or apologised for the error. All staff were quite flippant and said that he probably isn't allergic after all because he hadn't had a life threatening reaction. Not the point. He could have. It should not have been prescribed or given. If there was any query about his allergy status the risk benefit should have been discussed with him before administration. It wasnt. This was an error that seems to be brushed off by staff as 'well he looks ok. Must not be allergic' This is unacceptable. 

The following day medics decided not to continue taz or prescribe alternative until the cultures came back as he was not pyrexial. But again no observations were obtained or temperature checks done. I spoke with him on the phone around 1pm and he told me other than the Drs on the ward round in the morning and staff bringing food nobody had been near him. 

I called the ward to speak to the nurse in charge to highlight my concerns and clarify visiting policy as this had not even been mentioned to my dad on admission. He thought he wasn't allowed any visitors at all. The nurse assured me he was having regular observations and had recordings taken 4-6hourly since the event which had been unremarkable there for they would not increase these. I was reassured by this and spoke to my dad once more. He confirmed this was untrue. He looked at his observation chart hanging by his door. 2 sets of observations had been taken since admission. One at admission and one set in the evening. Both prior to the administration of the penicillin.

I told him to Buzz the nurses and ask to speak to the nurse in charge and ask why they would tell me on the phone he was being monitored closely when this was not the case. He was told that the nurse who spoke to me was unavailable and that because he wasn't unwell the frequency of his observations would be 12hourly. This was at 1430 - well over 12 hours from his last checks. He told her he wasn't really sure what the purpose of him being there was. He wasn't receiving treatment or being monitored and felt like he was bed blocking. Nobody has kept him updated and he's worried about the cause of everything not to mention being in hospital during the pandemic as a type 1 diabetic.

Shortly after a member of medical staff came to speak with him. Telling him his cultures were negative so no infection was present so antibiotics were not required. He awaits a surgical opinion. It had been mentioned on the ward round this am that the surgical team and gastro team would be consulted as they know my dad well. 

I'm hoping they can take over his care completely and he be moved to a surgical or gastro ward as I no longer trust that he is receiving the high standard of care that he should be. I recognise during this time staff and resources are stretched but I feel that should not impact patient safety. I'm deeply disappointed.