Summary
Mrs C complained on behalf of her husband (Mr A) who was treated for cancer at Aberdeen Royal Infirmary. Mrs C complained that there was a lack of communication about Mr A's care between the staff and his family and between the staff themselves. Mrs C also complained that Mr A was over-sedated which was causing periods of delirium and that his feeding and nutritional needs were not met.
We took independent advice from a nursing adviser and a consultant physician. We found that communication between hospital staff and Mr A's family and between hospital staff themselves was reasonable. However, Mrs C had raised concerns about Mr A having delirium and this was not appropriately acted upon in line with the Health Improvement Scotland (HIS) programme on identifying delirium in patients. On balance, we upheld this part of Mrs C's complaint.
In relation to over-sedation, the adviser said that the medication Mr A received is often accompanied by side effects and that it could have been a contributing factor to him developing a period of delirium. However, these side effects were not sufficient to say that Mr A's care was unreasonable or that he was over-sedated. Therefore, we did not uphold this aspect of Mrs C's complaint.
Finally, we found that Mr A was having difficulty eating and drinking and that this was due to damage to his mouth, a common consequence of the cancer treatment he was receiving. The adviser said that the hospital staff took reasonable steps to encourage and promote Mr A's nutritional care. There was evidence that Mr A had declined artificial feeding which would have improved his ability to eat. Therefore, we did not uphold this complaint.
Recommendations
What we asked the organisation to do in this case: Apologise to Mrs C for not appropriately acting on her concerns raised about Mr A having delirium. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.
What we said should change to put things right in future: Ensure that staff are following the HIS programme by involving families or carers in identifying delirium in patients and in their use of assessment tools to identify delirium in patients.
We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.
Related reading
View Decision Report 201607513 as a PDF (13.18 KB) Updated: December 2, 2018