"Male catheterisation in the community"

About: NHS Lothian Scottish Ambulance Service / Emergency Ambulance Western General Hospital / General Medicine

(as a relative),

It is deplorable that when male catheterisations are done in hospital they are done (I understand) by a male nurse or a doctor but in the community they are done by district nurses.

Virtually every catheter change in my father has resulted in an infection which in turn has caused hallucinations - very distressing for him and for those watching.

Catheter changes in hospital are covered by Gentamicin but in the community there is no automatic antibiotic cover. He has required hospitalisation 4 times in the last two years i feel as a direct result of the inability of the district nurses to do their job.

Supra-pubic catheter: exactly 2 years ago when my father was admitted as an emergency for the first time and it was said that he would be discharged with a catheter I asked if it might be possible for him to have one. The suggestion was summarily dismissed by the consultant. In the subsequent admissions to hospital the suggestion was met with increasing acceptance but of course it has to be done as a planned procedure (MORE cost) and cannot be done as part of an in-patient stay. Now, he wouldn’t agree to go in for the procedure even if it was offered.

So - the story of the last forty eight hours:

Over the last 2 years my 95 year old father has had to endure perhaps 8-10 catheter changes and, of those, I think 4 have resulted in hospitalisation because the district nurses either couldn't do it or caused so much trauma and bleeding that he required further help. This is completely unacceptable, putting to one side the issue of a supra-pubic catheter which would have negated most of the issues, if we are first to do no harm then district nurses need to be trained to an exceptional level.

When he goes to hospital, he uses up precious NHS resources. Earlier this week, after the district nurses had arrived and tried unsuccessfully to change the catheter around 11 am, my father was in pain and distress until he got to the Western and had his catheter changed around half past midnight. He was in retention and, when scanned, had 500mls of urine in his bladder. He had to be kept overnight to make sure all was well. So that was 3 visits by district nurses during the day, calls to NHS 24 where an on call doctor ok’d his hospitalisation. The “2 hour ambulance” did not arrive within the specified time, and, due to his deteriorating condition, a 999 ambulance was requested. This took 30 minutes to arrive. A bed in Acute Receiving, then a bed in ward 27, then a ward round then patient transport back to the care home. ALL AVOIDABLE COSTS.

No ward round was forthcoming on the day after his arrival and I managed to persuade the nurse that taking further bloods was not helpful. Just stop! The question that must be asked in each and every situation is: for whose benefit are we doing this? Certainly not my fathers in this instance.

The complete fiasco of his discharge deserves a post all of its own! The large catheter was changed for a smaller one and he was sent to the discharge lounge. I phoned at 5pm and the receptionist couldn’t find him on the system so went to look for him. He wasn’t in the lounge so the nurse told me he had gone. I phoned the care home and he hadn’t arrived so we assumed he was en route. Two hours later there was no sign of him and it turned out they hadn’t got him to the lounge in time for his slot so the transport had gone! They took him back up to ward and sat him in the nurses station plying him with cups of tea until they had to send him home in a taxi with an escort who I believe was doing it out of the goodness of their heart and in their own time! Patient Transport needs to sort itself out.

My father is 95, has stage 3 kidney failure, severe fluid retention, atrial fibrillation, possible prostate cancer, suspected bowel cancer, mild dementia and lost his wife of 66 years in February. He lives in a care home and has no interest in engaging in anything - he doesn’t want to be here, and he is very very scared of being in hospital.

As a matter of urgency can whoever reads this and has responsibility for district nurses who are allegedly qualified to change male catheters take immediate action to ensure that training is put in place to rectify this appalling situation. My father cannot be the only one who is suffering like this and it has to stop.

I have nothing but praise for the team that sorted him out within half an hour of arriving at the Western - absolutely fantastic and seemingly so simple for them to accomplish.

Perhaps district nurses could attend Acute Receiving on a regular basis and learn how to do this procedure and thereby save the NHS a significant amount of money and their patients a great deal of distress.

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Response from Sharon Hammell, Head of Corporate Affairs and Engagement, Scottish Ambulance Service

Good morning bordersgirl57

I am very sorry to hear about the distress caused to your father, particularly over the last 48 hours. I wondered if the best way forward regarding your feedback about the Scottish Ambulance Service is a conversation with Paul Bassett, our General Manager for South East Division. Paul's number is 0131 314 0141. Paul has read your feedback and is keen to hear from you to see how we can improve care for your father.

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Response from Jeannette Morrison, Head of Patient Experience, NHS Lothian

Hi Bordersgirl57,

Like Sharon I am so sorry to read of your father's experiences which clearly have been very distressing for him and his family.

I would be keen to offer my help and wonder if you would like to contact me directly in the Patient Experience Team and my details are (feedback@nhslothian.scot.nhs.uk) or by telephone 0131 536 3370 and l look forward to hearing from you.

Kind regards

Jeannette Morrison
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