"Gwent Gynae Ward and being discharged"

About: Royal Gwent Hospital / Gynaecology

(as the patient),

Unfortunately, I am a regular to the Gwent Gynae Assessment Unit and the Ward. Despite previously being told that I am known by them so can just ring them up and come in directly - this time I was told to be admitted through my GP, which is what I did and was admitted within the next hour and a half. I arrived at the gynae ward at 12:30pm.

I was seen in quick time by the doctor and found the nurse staff at that time to be very friendly. I was told that I would need a minor operation but needed to be seen by the senior doctor to make the decision and put me on 'the list'. I waited (without food or drink in anticipation of an operation) but was informed that unfortunately there was an emergency which meant I would probably have to wait (which was fine - I understand cases may be more important than mine) but at 5pm the senior doctor had been and gone without seeing me (which would have taken 5 minutes).

At half past 6 (which was 6 hours of waiting) I heard my doctor on the phone saying 'oh I did not get passed that decision' - reading between the lines from what was said to me after, the decision was to 'just put me on the list' (without being seen - which is what I had waited 6 hours for! ).

Following that decision being passed on, everything happened fairly quickly - the anaesthetists came to see me, a (very nice) nurse filled out a form with my details, I was given a bed on the ward and by 8:30pm I was in my gown and being taken to theatre.

The anaesthetists in the theatre did express shock that I had not been given fluids as I hadn't eaten or drunk anything since quarter to 9 that morning (12 hours ago).

The theatre staff (including anaesthetists and after care nurses) were excellent.

I stayed the night in the ward and was expecting to be discharged in the morning.

The nurse looking after me in the morning gave me my medication and tended to my needs post op at 9:30am. I was told that I needed to be seen by the Doctor before I could go who was 'on her rounds'. I waited and waited ever more impatient (knowing I was fit to leave).

I went to see the nurse for an update 'she's on her way round' I was told. at 11:30am my doctor finally came to see me but said she trusted the nurse's decision that I was fit enough to go home so didn't need to 'see' me (I thought to myself - what was the point in me waiting then, and taking a bed up that the hospitals always say they are desperate for!?).

The doctor told me that I needed to go home with antibiotics and would send the request to the pharmacy straight away. THREE hours later (now half past 2) I received my antibiotics from the nurse (who was seen doing a U turn on her way out for lunch after seeing me waiting in the waiting room, obviously reminding her to give me the antibiotics – who then had the cheek to say ‘good job I checked’! ).

If I had known the wait for antibiotics would be so long I would have asked for a written prescription to take to a local pharmacy (I was told by the nurse when I asked that question after 45 minutes of waiting that 'it's already in the system now sorry'. I was also told (by the doctor) that I could not go down to the pharmacy in the hospital myself to get them (for some unknown reason). In my opinion the most efficient way of dealing with this matter would have been for the nurse to have got the antibiotics organised so that when the doctor said I was OK to leave I could have left straight away.

When the nurse gave the antibiotics to me I asked 'shall I take these without food? ' she said 'no, they're antibiotics - it's best to take them with food' but the label on the box said 'take on an empty stomach'.

In conclusion, I had no complaints for the majority of staff I met. I was overall satisfied with the medical advice given to me. The operation itself was fine. The major issue was the long waiting times with poor communication between the doctor and senior doctors as well as the inefficiencies causing a major delay to me being discharged.

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Response from Julian Hayman, Internal Communications Manager, Communications, Aneurin Bevan Health Board

Hello Miss Scarlet,

Thank you for your feedback which has been received via the Patient Opinion website, and please accept our apologies for the delay in replying.

Senior Gynaecology medical cover is available on Ward B7 at the Royal Gwent Hospital every week day between the hours of 9.00 am to 5.00 pm; this includes cover for the Emergency Gynaecology Assessment Unit. Then out of hours arrangements are available for medical cover. We are sorry that you felt you were not reviewed in a timely manner and had a considerable wait before you saw a senior doctor.

The gynae ward is visited by pharmacy twice a day. The ward is extremely busy and has numerous discharges so it requires a morning (9-10am) and afternoon (2-4pm) visit. Pharmacy liaise with the ward to ensure discharges are completed within our turnaround time of one hour. Any discharges that are required outside of the pharmacy visit involves using the discharge pharmacist. The nurses on gynae are competent at processing their own discharges, if pharmacy are unavailable, this is for any items that are available as pre-packs. The ward also has access to a pad of WP10HPs which can be used to supply medication via a community pharmacy. All of these processed enable patients to be discharged in a timely manner.

Unfortunately this did not appear to be the case in your situation. Without your specific details, it is difficult to determine the reason, but possible problems may have been:

• Doctor waiting for post-op bloods to write discharge to determine if antibiotics were needed, this would have delayed the discharge being written

• Delay in waiting for the discharge to be written. Often the patient gets told they can go home on the post-take ward round. The Dr then see all other patients on the ward round before coming back to write the prescription. Unfortunately if there are lots of patients involving other wards, this can result in a delay. When the patient is told they are going home they expect it to be immediately, which is not always the case

• As for the patient requesting to get antibiotics from the community, if antibiotics are needed the nurses often like to ensure the patient leaves with these to start the course immediately. Unless they are confident these are readily available in community. This involves waiting for a hospital discharge to be processed

• If the prescription was written outside of pharmacy visiting the ward, we do not know if the discharge pharmacist was contacted, so the ward may have waited for the afternoon visit

• Nurses may have not been able to process the discharge without pharmacy input, again this is difficult without knowing what antibiotic this was

Further, regarding the incorrect labelling of the antibiotics:

All medication is labelled with advisory warnings for administration. These can vary from taking with/after food or on an empty stomach, depending on what antibiotic is prescribed.

It is good practice for the nurse to have given the patient the medication and gone through the directions with the patient, which would have involved reading the directions and advisory label. It seems this did not happen in this instance.

We are sorry for the delays that were incurred, poor communication received and labelling problems with your medication.


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