"Things that need to be learned from urgently"

About: Queen's Medical Centre / General surgery

(as a relative),

The good:

1) A&E consultant appropriately referred her to specialists after presentation with common acute symptoms.

2) Surgeons, Nursing and Ward Staff, Anaesthetics have got her through life-saving major emergency bowel surgery in past 48 hours (for which our family will be eternally grateful).

3) Superb care from 3rd on-call anaesthetist day 1 post-op who helped with pain management.

The bad (that things need to be learned from urgently):

1) 48 hours before the above: Presented to QMC A&E with same symptoms, alone, without me to help her express how unwell she felt (which was extremely). Was sent home to follow up with GP: - she felt like she'd been made to feel like she'd done the wrong thing presenting as emergency and was wasting peoples' time in A&E. (incidentally she got a taxi to A&E as didn't want to abuse ambulance services).

2) Second presentation to A&E (before Consultant reviewed and advised admission) - first doctor who reviewed, examined, and listened to both of us saying how terribly unwell she felt and how worried we were, advised she ought to go home and follow up with GP as previously planned (only changed his mind at last minute when I told him I was going to find the consultant and insist she needs admission this time).

3) Day 1 post op on E16: epidural analgesia (only significant med she was on after major bowel / abdominal surgery) completely stopped working down her right abdomen, and much less on the left..

She informed ward staff on E16 about how much pain was building up in abdo and pelvis - they got a surgeon to review who said: for pain team to review, and F1 to give buscopan IV.

She rang me at work and just said "I think I'm going to die of the pain I'm in and no one's helping - had it about 1 hour now.." - sounding like she really meant it. I drove from work - got there 25 minutes later - she still hadn't had any pain relief - found her laying dead still, eyes closed, trying to meditate herself to cope with the pain, and pulse rate 70 beats per minute ABOVE her normal baseline of 55.. (this is someone who's coped fine having two babies without much pain relief, and much more recently, 2 total hip replacements for arthritis + a revision total hip replacement)..

I pleaded to the doctor on the ward for more urgent pain relief and was told she was having buscopan and pain team was coming "soon", and they couldn't give anything else because there was an epidural in ..

I actually had to instruct them to call the on-call anaesthetists to come quicker to help - which they then did - and saved the day- I. e. got the epidural working again.

Myself and family are so upset to think she was in that amount of pain for about 2 hours and felt like she had to get me out of work to help her because her medical team weren't..

I am a medical doctor - worked at NUH NHS TRUST for years, as is my wife - so it devastates me to report these issues - but I know these things need to be highlighted at times so lessons can be learned.

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Response from Nottingham University Hospitals NHS Trust

Thank you for making contact with us. I am concerned to read your comments about how the behaviour of our staff impacted negatively on your daughter’s experience in our care and poor pain management. I would welcome to chance to discuss this with you directly. If you would like to do so, please can you get in touch with me at alun.harcombe@nuh.nhs.uk or by telephoning the hospital switchboard on 0115 924 9924.

Alun Harcombe

Divisional Director, Medicine