A medical practice in the Suffolk area

3. Miss A complains about the care she received from the Practice on 5 December 2019. She complains specifically that the Practice did not take out the sutures (also known as stitches), in line with discharge instructions.

4. As a result, she says she suffered pain and was traumatised. She did not want to contact the Practice again and she was left out of pocket.

5. Miss A wants a formal apology, and to be financially compensated.

6. On 20 November 2019, Miss A had a mole removed at the Skin Clinic at hospital A. The mole was on the sole of her right foot, and the wound was closed with four sutures.

7. On 5 December 2019, she went to the Practice to have the sutures removed. She was with her support worker.

8. She says the Health Care Assistant (HCA) then took all the sutures out but ignored her when she said it was hurting and that she felt unwell.

9. Miss A went to the chemist for steri-strips (thin adhesive bandages) and had to use these for the first two months after the sutures were removed.

13. When looking at whether there have been failings in the service provided, we first look to see what should have happened in the circumstances. We then look at what did happen, and if this was different. If it was, we consider whether it fell so far short of what should have happened that it was a failing. When we find that there was a failing, we go on to consider whether this caused an injustice. If it did, we consider whether the organisation concerned has already done enough to put it right, or if not whether we should recommend it takes further action.

Suture removal

14. Miss A complains the Practice did not remove her sutures in accordance with her discharge instructions. The discharge instructions said the sutures should have been removed alternately. She says her support worker rang the Practice beforehand and explained this would not be a straightforward suture removal, as the Skin Clinic had said the stitches needed to be removed alternately. The Practice say the HCA undertook correct clinical procedure for a small wound and removed the sutures concurrently.

15. The hospital discharge summary from 20 November 2019, indicates that primary care (a GP surgery) should be responsible for removal of sutures and to manage dressings. There were no specific written instructions in the discharge summary on how these sutures should be removed or who should remove them.

16. However, Miss A was given a sheet with aftercare instructions, dated 20 November 2019. This was given to her following her procedure by the Trust. This aftercare sheet is clear that the four sutures on the right foot should be removed alternately to check the wound, two weeks after the operation.

17. We would also consider guidance from the Marsden Manual. Section 15.3 of the manual covers the removal of sutures. The Marsden Manual advises that alternate sutures should be removed from a wound first, with the remainder removed if the wound stays securely closed. If the wound edges begin to separate during this procedure, then the remaining sutures should be left in place and reported to the medical team.

18. In this instance, the Practice failed to remove the sutures alternately as per the dermatology written information sheet. Meaning the Practice also did not perform the procedure in accordance with recommended clinical practice, as outlined in the Marsden Manual.

19. As a result of this, Miss A required further treatment as she says the wound opened. She says this oversight caused her pain and left her traumatised. Miss A made the HCA aware of the instructions she had been given in how to remove the sutures, and the Marsden Manual guidance says the sutures should have been removed alternately.

20. We can see the guidance outlines the sutures should be removed alternately to avoid the wound opening. It was also indicated in the aftercare sheet Miss A provided to the HCA that the sutures needed to be removed alternatively. This was not done and because of this we can see the wound opened, causing Miss A pain and discomfort. We will therefore be upholding this aspect of the complaint.

1. Based on the evidence we have considered we uphold this complaint. This is because the medical practice in the Suffolk area (the Practice) did not follow the discharge form, or the relevant guidelines, when removing Miss A’s sutures. This led to Miss A suffering additional pain and being financially out of pocket.

2. We recommend the Practice issues an apology to Miss A for this, along with a financial remedy of £250 for the failings identified.