Betsi Cadwaladr University Health Board

Mrs Y complained about her mother, Mrs A’s, care, and treatment by the Health Board during Mrs A’s admission to Wrexham Maelor Hospital between 22 July and 4 August 2020. She complained that the Health Board transferred Mrs A to a COVID-19 designated ward for treatment and treated Mrs A’s breathlessness and infection inappropriately. She further complained that the Health Board gave Mrs A incorrect medication on 31 July, took inappropriate action to address and treat a sore on Mrs A’s nose and withdrew active medical treatment inappropriately at the end of Mrs A’s life. The investigation found that the Health Board failed to provide a reasonable standard of care when it did not treat Mrs A’s infection appropriately and this element of the complaint was therefore upheld. The investigation found that the Health Board acted reasonably when it transferred Mrs A to a COVID-19 designated ward for treatment and treated Mrs A’s breathlessness. It also found the Health Board provided reasonable care regarding the sore on Mrs A’s nose and at the end of Mrs A’s life. Finally, it found that the Health Board’s prescription of Mrs A’s medication on 31 July was reasonable but identified the documentation recording that decision fell below standards. These elements of the complaint were therefore not upheld. The Health Board agreed to the Ombudsman’s recommendations to apologise to Mrs Y for the failures identified in this report and to satisfy itself that its own Pressure Ulcer Prevention/Management Care Plan is usually followed and accurately recorded by carrying out an audit of patients admitted with cases. If deficiencies are found, the Health Board should take appropriate steps to ensure compliance with its own Care Plan.