"Very thirsty when nil by mouth"

About: Western General Hospital / General Medicine

(as a relative),

My late mother was in the Western General Hospital, Edinburgh recently for 9 weeks. On the whole the treatment was exceptionally good and we were very pleased at the care she was given throughout. Sadly towards the end of my mothers life she had difficulty in swallowing and early one Friday morning a sign was put by her bed saying "Nil by mouth".

A request was made for someone from Speech and Language to come to assess her to see if she could take food / drink orally. Someone arrived around 4 or 5pm, but at the time of the visit my mother was very sleepy and it was impossible to assess her. I was advised they would return on Monday morning to reassess as there were no staff working over the week-end. I found this quite distressing as I was aware of just how thirsty my mother was and I knew that by Monday morning she would be incredibly thirsty. I was advised that her naso-gastric tube gave all the fluids and nutrition she required. We stayed with my mother most of the time and helped moisten her mouth with sponges on sticks. On the Saturday I noticed my mother was desperately sucking on the sponges and seemed able to swallow. Fortunately we knew the nurses well and after seeing her sucking on the sponges they agreed that she was now able to swallow and we could help give water via a straw. Over two or three hours she had several glasses of water and was as I expected very very thirsty and clearly the lack of fluid had caused considerable distress. After the exertion of the fluids and due to her medical condition my mother fell asleep and passed away late on the Saturday night.

Had my mother not passed away, had not been given any fluids and had had to wait till the Monday morning she would have been in great discomfort.

My concern is that patients cannot be assessed for being able to swallow and take fluids by mouth promptly enough or over the week-end and nurses apparently cannot always make the required decision. I am aware that it is important that fluids are not given in case of choking, however with my limited experience it was quite obvious that my mother was able to swallow and it was only our insistence that allowed fluids to be resumed.

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Responses

Response from Jeannette Morrison, Head of Patient Experience, NHS Lothian

Dear Dabbydaghter,

Please accept my condolences following the death of your mother. I was pleased to hear how you felt that the staff cared for your mother and the rest of the family.

I was, though, disappointed that when your mother was too sleepy to carry out the swallow assessment on the Friday evening, arrangements were not put in place for nurses trained in ‘swallow assessment’ to attend on the Saturday morning. A discussion could also have taken place with the you about giving your mother sips of fluids, when she was alert enough, for comfort.

I have shared your posting with the staff at the Western General with the hope that we can prevent this happening in the future.

Kind regards Jeannette Morrison

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