Mrs A complained about the care and treatment provided to her husband, Mr A, by Hywel Dda University Health Board (“the Health Board”), following his attendance to Glangwilli General Hospital (“the Hospital”) in August 2021. Specifically, she queried whether the treatment he received for gallstones reached a reasonable standard. She was also concerned that, during his second attendance at the Hospital, he was discharged when he should have been admitted for care. Finally, she was concerned the nursing care and treatment received by Mr A was not appropriate during his second attendance at the Hospital.
The investigation found that the investigations and procedures carried out during Mr A’s first attendance at the Hospital, and the resulting admission were timely and appropriate, and the treatment Mr A received for gallstones reached a reasonable standard. Accordingly, the Ombudsman did not uphold this element of Mrs A’s complaint. On his second attendance at the Hospital Mr A’s symptoms should have warranted an admission to hospital in order to administer antibiotics and management of his kidney injury. It is not possible to know with confidence whether admission to hospital would have prevented Mr A’s death, but this uncertainty is a significant injustice to Mr A’s family. This complaint was upheld. Finally, Mr A’s nursing care and treatment fell below standard because the Health Board failed to fully record the treatment prescribed to Mr A on his second admission, failed to note a pain score and, as a result, failed to fully assess Mr A’s needs. Consequently, the Ombudsman upheld this complaint.
The Ombudsman recommended that the Health Board should apologise to Mrs A for its failings and pay Mrs A £1,500 redress. She further recommended that the Health Board should provide a reminder to appropriate staff of the importance of following NICE guidelines correctly, specifically when a patient should be admitted to hospital, and the importance of documenting future treatment decisions accurately. Finally, she recommended that the Health Board should provide a reminder to relevant nursing staff of the expected standards for assessing and documenting a patient’s pain score.