Sheffield Teaching Hospitals NHS Foundation Trust

3. Miss B complains about the care provided by the district nursing team at Sheffield Teaching Hospitals NHS Foundation Trust (the Trust) after her hysterectomy surgery in March 2025.

4. She complains the district nursing team:

• failed to follow discharge instructions to remove her sutures within 10 days • failed to carry out appropriate wound assessments and notice her sutures.

5. Miss B says she experienced preventable wound irritation and infection, extending her recovery period. She says she had to use an additional two-week sick leave.

6. She says she experienced avoidable pain, distress, and anxiety about her care.

7. She would like the Trust to apologise, make service improvements and pay her a financial remedy.

8. In March 2025, Miss B had an abdominal hysterectomy (removal of the uterus through the abdomen). The next day, she experienced bleeding at the surgical site. The Trust applied dissolvable sutures (stitches) to Miss B’s wound under local anaesthetic.

9. Shortly after, the Trust discharged Miss B from hospital with follow up community care by the district nursing team.

10. In April 2025, Miss B noticed an unpleasant odour from her wound, and that she still had sutures.

11. Miss B raised this with a district nurse who removed the sutures, except one which was removed later. She also took a swab to test for an infection.

12. Miss B’s GP confirmed she had an infection, and she was started on antibiotics and also prescribed a steroid cream.

13. Miss B was discharged from the district nursing team in May 2025.

Removal of sutures within 10 days

17. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

18. Miss B complains the district nursing team did not remove the sutures on her wound within 10 days of discharge from hospital. She says this was outlined in the discharge letter from the Trust.

19. In the Trust’s complaint response, it says the sutures are dissolvable, and usual policy is to leave sutures to be dissolved.

20. Miss B underwent a hysterectomy in hospital at the Trust on 19 March 2025. She had superficial wound bleeding afterwards which the Trust treated with dissolvable sutures. She was discharged on 23 March 2025, to have her wound managed by the district nursing team.

21. On 31 March 2025, the district nursing team noted Miss B’s staples were removed, and the sutures appeared to be dissolving.

22. On 11 April 2025, Miss B noticed an unpleasant odour coming from her wound, and her daughter noticed the stitching. She raised this with a district nurse.

23. The district nurse noted a slight odour from the centre of the wound, which they swabbed for testing. The district nurse removed the sutures apart from one and requested a steroid cream. The remaining suture was removed on 14 April 2024.

24. The next day, Miss B’s GP confirmed her wound was infected and she was prescribed antibiotics.

25. The discharge letter sent to Miss B’s GP stated her sutures and staples should be removed within 10 days by the district nursing team.

26. The discharge letter was only sent to Miss B’s GP. The referral to the district nurses only asked for the staples to be removed. We recognise the instructions in the discharge letter has understandably caused Miss B concern about the care she received.

27. Our adviser said the district nursing team would not usually review the discharge letter sent to Miss B’s GP and it was appropriate for the district nursing team to follow the instructions set out in its referral.

28. The NICE CKS says dissolvable sutures break down in the body and do not require removal. It says most sutures should start to dissolve within 14 days, but some may take weeks or months to disappear completely.

29. In line with this guidance, Miss B’s dissolvable sutures did not require removal. Our adviser said when the district nursing team assessed Miss B’s wound on 31 March 2025, the sutures were noted to be dissolving. They said there was no evidence the sutures needed to be removed.

30. We appreciate the confusion caused by the Trust’s discharge letter to Miss B’s GP. The NICE CKS outlines that dissolvable sutures do not typically require removal within 10 days. We consider the district nursing team acted in line with this guidance by leaving Miss B’s sutures to dissolve. Therefore, we are not investigating this complaint further.

Wound assessments

31. Miss B complains the district nursing team at the Trust did not complete thorough wound assessments, missed the sutures being left in and missed her wound infection. She does not think all of the nursing staff reviewed her notes properly before each visit.

32. Section 3.5 of the NMC guidance say nurses should demonstrate the ability to accurately process all information gathered during the assessment process to identify needs for individualised nursing care and develop person-centred evidence-based plans for nursing interventions with agreed goals.

33. The IMI guidance says clinical photography of a patient’s wound can be used to provide a record of the natural course of, or impact of treatment on a condition.

34. The district nursing team first visited Miss B on 31 March 2025. It completed a wound assessment template plan, including photos, measurements and wound descriptions. The district nursing team planned to visit her again in four days’ time.

35. On 4 April 2025, the district nursing team assessed Miss B’s wound, describing the wound and noting there was no sign of infection or pain. The wound was redressed following the wound care plan.

36. On 8 April 2025, the district nursing team updated the wound assessment template with repeat photos, documenting the wound was healing nicely. The district nursing team cleaned the wound with water.

37. Our nursing adviser said the district nursing team assessed Miss B’s wound appropriately, identifying her needs by developing a wound care plan. This is in line with section 3.5 of the NMC guidance quoted above.

38. In line with the IMI guidelines, the district nursing team took photographs of Miss B’s wound to monitor how her wound progressed.

39. Wounds UK 2010 says a wound infection is initially identified by the recognition of clinical signs and symptoms such as pus or cellulitis. Wounds are swabbed in order to develop a laboratory culture, which will establish the causative organism and ensure appropriate treatment is started.

40. On 11 April 2025, Miss B noticed an odour from the wound and her remaining sutures. A district nurse assessed the wound and documented a slight odour to the centre of the wound. They swabbed the wound, took imaging and cleaned the wound with cool, boiled water. They also removed the sutures except one suture due to the position and arranged for a joint visit to remove this final suture.

41. Our adviser said it was appropriate to take a swab to determine the type of infection, and to remove the dissolvable stitches as infection can slow this process down. This was in line with the guidance by Wounds UK 2010.

42. Wounds UK 2011 says steroids can be used to reduce the inflammation of the wound and stop the production of overgranulation tissue (the excessive growth of tissue above the wound surface).

43. On 14 April 2025, the district nursing team removed Miss B’s final suture. The wound was noted to be ‘overgranulating’. The team requested hydrocortisone, a topical steroid cream, to treat the wound. This is in line with the advice set out in Wounds UK 2011 for treating overgranulation.

44. On 15 April 2025, Miss B was prescribed antibiotics after the swab taken by the district nursing team confirmed an infection.

45. The district nursing team visited Miss B on 17 April and 21 April 2025 and assessed her wound. They noted her infection was clearing and the wound was redressed. The overgranulation was clearing up with the steroid cream.

46. By 24 April 2024, the wound assessment plan was updated as the wound had closed. She was discharged from the district nursing team on 5 May 2025 as the wound had fully healed.

47. NMC The Code says a nurse must assess need and deliver or advise on treatment, or give help without too much delay, to the best of their abilities, on the basis of the best available evidence.

48. Our adviser said the district nursing team carried out thorough wound assessments and promptly treated Miss B’s infection and overgranulation. This is in line with NMC The Code in assessing and delivering treatment without a delay. They said the records clearly documented the wound on each visit, in line with the wound care plan.

49. They said there was no indication the district nursing team did not follow Miss B’s wound care plan, as the nursing team used the same treatment and approach at each visit.

50. We are sorry Miss B felt the district nursing team failed to assess her wound thoroughly. We have seen evidence the district nursing team assessed the wound thoroughly and responded promptly to treat the infection in line with the above guidance. As we have not seen any indications of failings, we will not consider this complaint any further.

1. We have carefully considered Miss B’s complaint about Sheffield Teaching Hospitals NHS Foundation Trust (the Trust). We are sorry to hear Miss B is unhappy with the wound care she received by the district nursing team at the Trust, and that she developed an infection in her wound. We recognise this extended her recovery period and she had to take more time off work.

2. Following our consideration of Miss B’s concerns, we have seen evidence the Trust’s district nursing team provided treatment in line with national guidance and appropriately managed Miss B’s wound. As we have not seen indications of any failings by the Trust, we are not investigating further. We are sorry for any pain and distress Miss B experienced due to her infection.