"Good care, poor discharge procedure"

About: Princess Alexandra Hospital (Harlow)

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My mother was recently a patient at the hospital and I believe that up until her discharge she received very good care. Part of the reason she was admitted was that she was not coping with her medication and complex health needs at home. We therefore met with nursing and medical staff to discuss what strategies could be put in place to ensure that she was not re-admitted for similar reasons. I explained that not only is she confused, but that my stepfather who cares for her is too. For example he recently told me that my mother was not on warfarin before she went into hospital, but she has in fact been taking it since her previous admission to hospital in October. The support agreed included assessments by a Physio therapist and an Occupational therapist and the provsion of appliances and carers to help her at home. All of these things were carried out and provision put in place as promised. The other need identified was for her medication to put into dossette boxes, so that she could be sure of taking the correct dosage of the 12 different drugs that she needs. I was told by the ward manager that this would be organised. However, when she was discharged, she was just presented with a carrier bag full of boxes of tablets and a list of what to take. Many of the tablets were ones she took in with her, some of which she no longer takes and some were prescribed to her husband. Some of the ones she does now take have the wrong dosage written on the box. Therefore the only way to determine the correct dosage is to consult the list she was given. So she has to check the size of each tablet and work out how many of each to take; not easy when you are 81 and confused. In addition abbreviations such as OD, BD etc are used on the sheet to denote frequency, although very familiar to medical staff it should not be assumed that patients understand this. I did complain about this at the time but was told that nothing could now be done. Although my mother was told that she needed to be ready to go at 1pm, she did not in fact leave until after 7pm, as a blood test had to be done and then repeated because 'it came back void'. We were also informed that she would need another blood test on the Monday to determine her warfarin dosage. My mother requires a home visit by a nurse for this, which turned out to be impossible for us to organise at such short notice. The GP has informed me that the hospital should have arranged it prior to her discharge. I therefore feel that although my mother's care in hospital was good, the discharge procedure was unsatisfactory and unsafe.

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Response from Princess Alexandra Hospital

Dear Anonymous, While I am pleased your mother received very good care, I am really very sorry that the discharge did not go as well as we would wish. The Trust is working hard to improve discharge processes which we know are a challenge for us in particular and so your message really affirms to me that we have a lot of work to do to resolve this. The anonymity of your comment means we cannot review the individual records to look at the reasons for the three key questions you have but I will try and respond in general and would also be keen for you to come in to speak to the Directors and the team about your experience, the number to call is at the end of this comment. Specifically, you were trying to ensure support for her after discharge was clearly established and this does not appear to have happened, the dossette boxes were not made up and discharge took place later than you had hoped or expected. All of these issues should have been better handled, even if perhaps we had advised you earlier that there would be a delay in discharge or that Trust Policy is not to use personal dossette boxes, I am sure this would have helped. Although I am pleased that the assessments by the Physiotherapist and Occupational Therapist took place and the appliances were provided, the unfulfilled parts of the care planned do appear to me negate the value of these good outcomes and so I would be keen for you to come and see us. Please make contact by calling 01279 82 70 84 and we will do everything we can to help.

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