"Concerns about my father's care in A&E department"

About: Queen's Medical Centre / Accident and emergency

(as a relative),

My father was taken to A&E via ambulance, following an unexpected seizure at home.

He had finished his own shift as a psychiatric nurse and come to join his family for Sunday lunch. Within 10 minutes of arriving he became unwell, was behaving in a bizarre manner, was unable to communicate and started to have a seizure.

An ambulance was called and myself, my mother and sister remained with him ready to perform CPR when he began to choke and appeared to be performing only agonal respirations. Thanks to us being nurses we were able to recognise the signs and symptoms and responded appropriately.

The ambulance crew arrived within approximately 5 minutes and were fantastic. Kind, caring and able to provide the reassurances we needed that my father would survive. They were unable to explain what had happened and why but assured us that upon further investigation this would be identified. My mum went with my dad in the ambulance and my 2 sisters and me followed them to the QMC.

Upon arrival we waited in the waiting area with my mum and were surprised to see my dad walk from a cubicle in to the waiting area. It was a relief to see him walking and able to recognise us again however we were concerned regarding his instability, cognitive ability and given how his first ever seizure had so unexpectedly occurred we were worried this may happen again and so were worried he had been left to walk unaided.

His work uniform was cut down the middle making his torso visible to everyone else waiting in that area, he was offered no gown and therefore no way of maintaining his dignity. Luckily we'd taken his jacket and could ensure he was covered however the staff did not know this.

The A&E department was dirty, vomit was left uncleaned on the floor for approximately one hour whilst patients and visitors walked past it and trolleys were wheeled through it, wet paper towels were under the chairs, sick bowls and glasses of water were left as patients were unable to clear them themselves. A patient had his physical observations done in the waiting area, I knew one patient had been for a chest X-ray as this was shouted across the waiting room by a nurse. Patient confidentiality appeared to have little consideration.

During our wait we got some drinks. We asked a nurse in the office if my dad would be allowed one. She asked only what he had been admitted with and did not ask his name in order to properly assess this. Upon being informed he'd had a seizure she agreed this was ok however did not know the issues surrounding this. After waiting for 2 hours to see a medic with my dad confused at times, repeating himself and appearing to not understand the enormity of the situation the doctor he saw discharged him stating he would be offered an MRI at some point during the week. Other tests also confirmed that he had previously suffered a heart attack. The only information we were told about this was that it was historical however no reassurances or advice regarding this was offered.

My dad was sent home not knowing why he'd had, at the age of 53, his first ever seizure, if or when this would happen again and how this may be prevented. As a family we are terrified and have no idea whether this will happen again. We have therefore not left his side knowing that had we not been there with him at the time this occurred he would have undoubtedly choked to death.

We got up yesterday morning ready to book him in for his MRI. The neurology department said they didn't know of my dad despite the doctor he saw in A&E saying he would email them. Their response was that "he could have emailed anyone" and if this was urgent they'd have contacted us.

My mum called the family GP who appeared to be horrified that my dad had been allowed home following this completely unexpected seizure and stated he should have had all of the necessary tests in hospital to establish a cause before being allowed home. He prescribed painkillers for the effects of the seizure on the muscles in his back as this is causing him extreme pain. Upon reflection we now wonder if an x-ray should have been performed to rule out secondary injuries however this was not.

In excess of 48 hours in we know nothing more and are keen to ensure my dad and his family can be reassured that this was either a one off event or something treatable.

In addition we have noted that NICE guidelines have also been breached and I have highlighted for example 2 of those points below however I could have chosen many:

1. 4. 5 It is recommended that all adults having a first seizure should be seen as soon as possible by a specialist in the management of the epilepsies to ensure precise and early diagnosis and initiation of therapy as appropriate to their needs. [2004]

1. 4. 9 Essential information on how to recognise a seizure, first aid, and the importance of reporting further attacks should be provided to a child, young person or adult who has experienced a possible first seizure, and their family/carer/parent as appropriate. This information should be provided while the child, young person or adult is awaiting a diagnosis and should also be provided to their family and/or carers. [2004]

Currently we know nothing and are incredibly fearful this will happen again.

It is only upon coming home that we have been able to gather our thoughts and reflect upon the experience as one that has not only understandably shaken us because our son, husband and dad became Ill but because we have no reassurances as to whether this can get better.

As a family of nurses we are incredibly saddened to have witnessed this practice in the NHS in which we all feel so strongly about. We understand the staffing crisis better than the majority of NHS patients however the care received last night was not seemingly a reflection of this.

I would appreciate a prompt response regarding my concerns. If contacted through this forum with relevant contact details for the relevant professional I will respond via telephone.

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Response from Nottingham University Hospitals NHS Trust

Hi Emma. Thank you for getting in touch and for sharing your detailed account of your father’s experience and indeed your own as a family member. I’m deeply concerned to read your comment. I would like to propose that we ask that this is escalated and becomes a formal complaint so that we can look into this fully for you. I have shared your complaint with our Patient Advice and Liaison Service and the Matron in our Emergency Department so that this can be investigated for you. Our PALS team would appreciate it if you could contact them directly (to share your contact details) on 0800 1830204 so that they can look into ASAP.