"Inadequate pain relief in A&E"

About: Warwick Hospital / Accident & emergency West Midlands Ambulance Service NHS Foundation Trust / Emergency ambulance

(as the patient),

Just to set the scene, I have a digestive disorder which has led to the removal of my colon and have suffered with ongoing digestive problems since. I was also due in hospital for a routine surgery three days after the incident described below.

I was taken to hospital in an ambulance with excruciating upper abdominal pain after calling 111. En- route the paramedic stopped the ambulance to insert a cannula so he could administer morphine (I was already on gas and air). Unfortunately it was unsuccessful (it is difficult to insert cannula) and they decided to rush me in to A&E for treatment.

I arrived and was given an ECG, forms were filled in and my wristband printed. Half an hour later I was given two paracetamol tablets and a codeine tablet, which I immediately threw up, though this was not noted.

My obs were then taken which were deemed to be "normal" (124/90ish). Though I usually have low blood pressure (around 90/60) which I know is recorded in my previous patient case notes. I overheard a nurse say what sounded like "her obs are normal, a little too normal if you know what I mean".

I was becoming concerned that no attempt had been made at a cannula, and that I would not get any significant pain relief until this was done. Since I am difficult to cannulate, I mentioned my worries to the nurse and she responded "is that what you come here for, the morphine?" In my agony I was in no state to argue and did not respond to the comment, but it made me feel like I was assumed to be a drug seeker.

In my writhing due to the pain I had knocked an empty sick bowl on the floor and a student nurse came in and quite literally threw it on the bed and said "don't drop that!" with what seemed to me an essence of disgust. I was sick again and was left holding the bowl for a significant period of time as I did not want to knock it off the bed again. The bell to call for help had not been left within reach.

I was told I needed an x-ray and that I was not allowed to go until I had provided a urine sample. I was told the toilet was down the corridor. I did not think I could make it there and asked the nurse for help but she just left saying that I would not get the x-ray until I had done it. In immense pain (still no pain relief) I dragged myself to the toilet and provided the sample.

2 Hours later I was finally given 4 paracetamol which had no relieving effect on the pain.

A man who told me he was the "most senior doctor present" came to take an arterial blood sample, but did not ask me anything or give me any information.

2 and a half hours later I was moved to the ward where I was finally given 4 morphine and was very sick again. The pain began to subside.

I was told I had had a gallbladder "attack" (apparently more painful than childbirth) and a bowel obstruction (potentially life threatening).

I would like to know if the treatment I received (in respect to pain relief and what seemed to me the bad attitude of the nurses) was routine for someone presenting with my symptoms and history, or if it was in any way affected by my thinking that there were assumptions by the nurses that I was a drug seeker.

I would also be interested to see any guidance which is provided to nurses in the NHS on how to handle suspected drug seekers, and the standard procedures which should be followed with respect to pain relief in A&E. I know these documents must exist.

Thank you for reading this long story. I would be grateful for any advice.

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Response from Regional Head of Patient Experience, West Midlands Ambulance Service

Dear AandEangry

I am sorry to hear of your recent experience and I hope you are making a recovery following this incident. Should you wish to discuss any aspect of your care whilst with West Midlands Ambulance Service please do not hesitate to contact me on telephone number 01384 246366 or by emailing pals@wmas.nhs.uk

kindest regards


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Update posted by AandEangry (the patient)

Thank you Marie for your response. I would like to add that the paramedics from your ambulance service were professional, understanding and reassuring at every point during my time in their care. My worries about my treatment are only related to my time in A&E.

I do wonder, that when your crew do such an excellent job of rushing me to hospital with blue lights flashing, why I am then left without adequate pain relief for 5 hours. It seems there is a significant discrepancy between the assessment of the WMAS and A&E, which, in my opinion, defies all logic.

I cannot thank the paramedics enough.

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