Source · SPSO (Scottish Public Services Ombudsman)

Greater Glasgow and Clyde NHS Board

SPSO (Scottish Public Services Ombudsman) Partly Upheld Reference 201508773 Sector Health Category clinical treatment / diagnosis Decided 01 February 2017

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Full decision

Summary

Mrs C complained about the care and treatment of her late father (Mr A) who was admitted to Queen Elizabeth University Hospital with pneumonia. While Mr A's health improved at first, he contracted sepsis (an infection in the bloodstream or tissues). Although he was given antibiotics, he died a few days later. Mrs C raised concerns about the medical and nursing care and queried why antibiotics were not started earlier. Mrs C also complained that she was not properly recorded as Mr A's power of attorney and that staff did not include her in important discussions about his future care.

Staff from the board met with Mrs C on two occasions and apologised for some aspects of care. However, they considered the medical care was reasonable and said staff did not consider the power of attorney was relevant as Mr A still had capacity when he made decisions about his care.

After taking independent medical and nursing advice, we did not uphold Mrs C's complaint about medical care. We found staff appropriately administered antibiotics when Mr C's blood tests showed signs of infection. We upheld Mrs C's complaint about recognition as power of attorney, as staff had incorrectly recorded 'N/A' in relation to power of attorney on Mr A's admission notes. However, we found that it was reasonable for staff not to include Mrs C in the discussions about Mr A's care decisions as Mr A had capacity at that time and asked the doctor not to discuss these decisions with Mrs C.

We found that the overall nursing care had been reasonable. Although the board acknowledged there had been issues with call buzzers during the admission and a catheter bag that was not placed on a stand, they had taken appropriate action in response to these issues.

Recommendations

We recommended that the board: apologise to Mrs C and her family for the failings identified; and ensure they have adequate processes in place to monitor that power of attorney is being accurately recorded on admission.

Related reading

View Decision Report 201508773 as a PDF (12.97 KB) Updated: March 13, 2018

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