A hospital in the Reading area

3. Miss R complains about the care and treatment the Hospital provided on 27 November 2020, when she attended for a COVID-19 swab test. Miss R tells us the nurse who carried out the test pushed the swab stick forcefully into her left nostril causing her intense pain.

4. Miss R says her left nostril was injured, and she is experiencing long term symptoms, for which she has sought medical assistance and she has been referred to a specialist consultant for further treatment.

5. As an outcome to her complaint, Miss R is seeking an acceptance from the Hospital of failings in the care it provided, an apology, and a financial remedy.

6. Miss R attended a scheduled appointment at the Hospital on 27 November 2020 for a COVID-19 swab test. This was a requirement before her planned surgery.

7. The testing site was situated in the Hospital car park. Miss R says when she arrived, two nurses approached her car, they did not greet her, and one asked if she was there for a COVID-19 test. The nurse asked Miss R if she had a test before and Miss R replied she had, so the nurse dropped a tissue into her lap and said, ‘well you know what to do with this then’.

8. Miss R says the nurse then swabbed her throat, and without warning, forcefully pushed the swab into her left nostril. Miss R says this was extremely painful and she jumped back in her seat. She complained to the nurse who said they were doing it correctly and had not inserted the swab too far. Miss R says the other nurse, who had not spoken at all, turned and walked away from the car.

9. Miss R then allowed the nurse to swab her right nostril and while she flinched initially the swab test was completed.

10. Miss R says she was left in pain following this test and complained by telephone on 30 November 2020 to the Hospital. She tells us she received a call a few days later from the Hospital and was told the nurse who carried out the swab test had said they did not intend to hurt Miss R, and it apologised for any distress caused.

11. Miss R had a telephone consultation with her GP on 31 December 2020 about her nose, as she was still in pain. She was prescribed with Naseptin nasal cream. This is a medication which contains an antibiotic and a disinfectant and is used to treat and prevent infections in the nose. The doctor explained it was unlikely Miss R had a perforation, but it may be soft tissue bruising. The doctor agreed to review in two weeks.

12. On 1 January 2021, Miss R sent a complaint to the Hospital which it acknowledged on 5 January 2021.

13. As she was still experiencing symptoms, Miss R attended a face-to-face consultation with her GP on 11 January 2021. They examined her nose and recorded rhinitis (inflammation of the lining of the nose), deviated septum from right to left (a deviated septum is a relatively common abnormality of the nose where one side of the nasal passage is smaller than the other), and no perforation (a perforation is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure).

14. The doctor decided to treat as rhinitis and prescribed fluticasone nasal spray (fluticasone is used to relieve seasonal and year-round allergic and non-allergic nasal symptoms, such as stuffy/ runny nose, itching, and sneezing). The doctor advised if the symptoms persisted then it may be appropriate to refer Miss R to an Ear, Nose and Throat (ENT) specialist for further investigations, and a possible computerised tomography (CT) scan, due to the clear fluid drip from the left nostril.

15. The Hospital provided a response to Miss R’s complaint on 27 January 2021. It explained the COVID-19 swab test procedure and how some people may find it more uncomfortable in one nostril compared to the other. It also confirmed the staff carrying out the testing had been fully trained, and while it acknowledged Miss R’s concerns, it did not uphold her complaint.

16. Miss R was not satisfied with the response and escalated her complaint to the Hospital on 1 February 2021. This was acknowledged on 9 February 2021.

17. On 23 February 2021, Miss R’s GP made a referral for her to be seen by an ENT specialist.

18. The Hospital sent a final response to Miss R’s complaint on 17 March 2021 stating it had reviewed the medical notes. In these it was documented Miss R had experienced pain in her left nostril and the nurse had tried to explain what could cause this. It said the nurse did not attempt to repeat the test in the left nostril again. This supported the nurse’s practice to minimise harm, and as the swab had been taken from the right nostril without incident, this demonstrated the correct administration of the COVID-19 swab test. The Hospital did not uphold the complaint.

19. Miss R tells us she was assessed by an ENT Consultant and no injury to her nose was diagnosed. She also had a CT scan, and this did not identify any mechanical cause for her nasal drip.

21. Our Service Model Guidance (SMG), the guidance which underpins the work that we do, says in Section 3.38: in reaching a decision as to whether the clinical care and treatment provided was reasonable, we should consider the evidence provided to us by all parties. By evidence we would include but are not limited to; eyewitness accounts provided by the complainant or others present, medical records, and clinical advice.

22. Section 7.10 of this guidance says, in some cases, there may not be enough evidence, or the evidence is so equally balanced that even on the balance of probability we cannot come to a view.

23. We are aware the UK Government guidance on swabbing, ‘guidance for taking swab samples’ sets out that the swab stick should be inserted into the nostril gently and wiped around the inside of the nose. It states no force is needed and the swab stick does not need to be pushed considerably far into the nostril.

24. Miss R says a nurse incorrectly carried out a COVID-19 swab test on 27 November 2020 by forcefully pushing the swab too far into her left nostril.

25. She says this caused her extreme pain and has left her with ongoing nasal symptoms. These include her left nostril being extremely sensitive to the cold and a nasal drip. Miss R says the nurse wanted to try again in the left nostril and she did not consent to this but did consent to her right nostril being swabbed. Miss R tells us she attended her appointment in her car on her own, so there is no one else that we can consider as an independent witness.

26. Miss R says she did not have any previous medical issues with her nose and had previously had COVID-19 swab tests without incident. She says her symptoms started after her COVID-19 swab test at the Hospital on 27 November 2020.

27. Miss R has been attending her GP for treatment and was referred to an ENT Consultant for further investigations. Miss R has had several tests which have not identified a diagnosis for her symptoms.

28. The Hospital investigated Miss R’s complaint, and this included reviewing the medical records made at the time of the test, and her GP medical records, which she had consented to. It also took statements from the nurse and health care assistant (HCA) who carried out the swab test on 27 November 2020.

29. The complaint was not upheld by the Hospital as it was documented in the medical records and the statements made by the staff that the correct procedure had been carried out. It did say Miss R had said she experienced pain when the swab was inserted into her left nostril, and the nurse had explained that the swab needed to be inserted further to obtain a correct sample.

30. The Hospital stated Miss R may have experienced pain as she had a deviated septum (as documented in her GP medical records), which meant her left nostril was smaller than her right. It went on to say there was evidence the right nostril was swabbed without incident and this supported the correct procedure was being carried out.

31. Here we have a situation where Miss R says a COVID-19 swab test was carried out incorrectly, and the Hospital saying there were different accounts given by staff about what happened.

32. In line with our SMG (3.38), we have carefully considered Miss R’s clinical records from the Hospital, and her GP medical record of her consultations. We considered if we can apply a balance of probability. By this we mean, taking a view that something is more likely than not to have happened from either evidence we have available or the weight we may place on some evidence. In this instance, we are faced with differing accounts of the incident, and no third party independent impartial evidence to reach a view meaning we cannot say with any certainty what happened.

33. It is not our intention to dismiss Miss R’s account of what happened, but as an independent organisation, we were not present at the time she underwent the COVID-19 swab test, and there is no robust evidence which would enable us to reconcile what happened here. Also, Miss R’s ongoing medical consultations have not identified any clinical swab injury, or a diagnosis for her nasal symptoms that could be linked to the COVID-19 swab test.

34. We considered our SMG (3.13) in deciding if proposing to move to a full detailed investigation would provide additional evidence to reach a decision on this concern. Informed by this guidance, we consider a detailed investigation would still present the same challenges, in that the detailed investigation would not be practical nor reach a satisfactory conclusion. This is because we would still face the same situation where we are unable to reach a view due to the lack of impartial evidence available.

35. As such, in line with our SMG, as there is not enough evidence, we are unable to reach a view and say confidently whether there have been any indications of failings here. We will therefore take no further action.

1. We have carefully considered Miss R’s complaint about a hospital in the Reading area (the Hospital). We are unable to determine if there are any indications of failings and as such, have closed this complaint as other reasons to decline a detailed investigation.

2. We were sorry to learn about the pain Miss R says she experienced during her COVID-19 swab test at the Hospital, and the ongoing symptoms she tells us the test caused. We recognise our decision will be disappointing for Miss R.