"Concerned that this will affect future care"

About: Aberdeen Royal Infirmary / Acute Short Stay Medicine Aberdeen Royal Infirmary / Emergency Medicine

(as a parent/guardian),

My daughter had been outside with her friends for a good few hours (it was cold and damp air) when she suddenly became breathless and tight chested.  She took her blue inhaler which had no effect.  She was a few minutes from her dad's house so tried multi dosing with the spacer there, this did not help.  She was obviously upset that she could not breathe properly and the multi dose of Salbutamol was making her feel tingly, along with the fact she could not breathe properly.  It is also natural to panic a little during an asthma attack.

Her dad took her to A+E as she was staying at his and they took her straight through.  She was obviously tummy breathing and struggling to talk in full sentences.  Her peak flow was down and breath rate up.  Staff here were fully aware that asthmatics do not need to have wheeze during an attack.   She was given a total of 3 nebulisers, steriods and another asthma med.  This treatment calmed the attack but staff wanted her to be monitored for the night because she had needed a few nebulisers and her peak flow was still not back to baseline.  A+E staff were fantastic and very reassuring.

She was put up to Ward 103 for the night.  The night staff were lovely and very helpful as this was my daughter's first stay in the adult hospital.  She was given a nebuliser in the morning for some residual tightness. 

When she was reviewed by the doctor in the morning, her asthma was dismissed and it was stated that she had infact had a panic attack and not an asthma attack.  The reasoning for this was that she was told that asthma cannot come on suddenly in cold air (she had been out in it for hours and had got over a viral bug the week before).  Also it was stated that an asthma attack due to trigger of cold air would not lead to an overnight admission (A+E said this was the best plan and that she would get out in the morning if all okay). Apparantly the nebulisers had purely provided a "placebo effect" (even though they improved her peak flow) and the doctor told her that the peak flow drop was not caused by her asthma.  I do wonder if the doctor noted her referral for the eating disorder clinic and if this led to the conclusion of anxiety?  I do not believe that A+E medical staff would administer multiple nebulisers and other meds for a "placebo affect".  

My daughter obviously got annoyed at this as she has had asthma since the age of one and knows what her flare ups feel like.  Her asthma is very well controlled in-between attacks.  She asked to speak to someone else and the same doctor returned stating that that was their opinion and end of basically.  She did get upset that she felt she was being told she was lying that it was her asthma, which probably didn't help with the anxiety attack diagnosis, but not being able to breathe properly the night before, being up.most of the night and then being told that, would lead anyone to feel a tad emotional.

A+E staff saw her at presentation, and I feel that they were best placed to see what was happening at that exact time and commenced treatment for an asthma attack.  

My daughter now feels that her referral to the eating disorder clinic will now affect her future care (it took a lot of work to get her to agree to this in the first place).  She was discharged home later that day (she wanted to go home) with 4 days of steriods for her "anxiety" (noted for asthma on the discharge letter from wd 103).  Reason for admission was stated as anxiety.  

She is concerned that this will now affect her future asthma care.

Responses

Response from Fiona Robertson, Chief Nurse, Medicine and Unscheduled Care Division, NHS Grampian

Dear Jester

Thanks for sharing the experience that your daughter had when she attended A&E and then admitted to ward 103. Her episode of breathlessness and chest tightness must have been very frightening for her and also given that this was her first stay within the adult hospital setting. I am pleased to hear that the A&E staff and night staff were helpful towards her but disappointed regarding the experience that she had when she was reviewed by the Doctor the following morning and I apologise for any distress that this review and discussion caused her.

I will share her experience with the team in ward 103, including the Doctor which will allow reflection and review of communication and person centred approach to care.
In regards to your daughters concern regarding any future care, referral to a clinic should not affect any future care needs and again apologise that her recent experience has caused such concern.

With best wishes to you and your daughter

Regards

Fiona Robertson

Chief Nurse

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