"Concerns over nutrition and fluid"

About: Royal Alexandra Hospital / Stroke Care

(as a relative),

Last week my mother who is 87 suffered a stroke. She was taken from A&E at the Royal Alexandria Hospital (RAH) in Paisley to the Queen Elizabeth University Hospital (QE) in Glasgow.

After a week in the QE she was transferred back to the RAH yesterday. I checked the RAH website and eventually found that visiting at the RAH was identical to the QE from 13. 30-20. 30 hours. I arrived at Ward 4 of the RAH at around 17: 00 and asked for my mother. I was advised by a man I assumed to be a doctor that she was in a room. At that point a woman in uniform told me the ward was closing for protected mealtimes. I expressed my surprise and said I had checked the website before travelling and saw no sign of that. I also advised that at the QE hospital, patient families were welcome to support feeding and that I had done so there and was happy to do so if permitted. I was bluntly informed that I could stay but only one person could be involved in the feeding process. As I was on my own I was not sure why this was mentioned.

I subsequently discovered my niece was in the room with my mother, obviously having just arrived I could not know this and found the attitude of the woman quite disconcerting. I went into the room and my niece advised me that she had been assured my mother would have food provided at mealtimes. My niece further advised me that there seemed to be some confusion around what my mother could have. She was advised by one nurse that rice was acceptable whilst another said it was not. She finally got agreement that my mother could have ices cream or custard. My niece went to the shop to buy this and returned and fed my mother a tub of ice cream. My niece left and I sat with my mother. No food arrived but as my mother was exhausted from her transfer from QE I left her asleep but was concerned that no one had brought food or checked on my mother. about this. At around 18: 05 my mother awoke and after a few moments said she needed the toilet. I went out into the ward but as all the staff seemed busy went back to the room and pressed the buzzer at 18: 11, the nurse finally arrived at around 18: 21 hours. I expressed my concern about the lack of food and was told that my mother had been fed. I queried this and was told again by a nurse that she had been fed. I asked what would have happened had I not been there to question the no appearance of food and was told "We would have asked the patient".   I am no expert but I am concerned that an older person might reasonably be expected to be confused after the stress of hospital transfer and think they had been fed and had not been.   I expressed the view that there seemed no system in place to check that food had been served. I also expressed the view that in some cases older people who had experienced a trauma such as a stroke might not be able to communicate and therefore the lack of nutrition or fluid would pass unnoticed.

I contacted my niece via text and she assured me that all my mother had had was ice cream since 2pm. I spoke to the nurse and the woman in uniform who had spoken to me on my arrival came up and the nurse left. The woman pointed out that as my mother was a new arrival the system had clearly broken down. I accepted that this had happened but asked why. I pointed out the possible outcome of an 87 year old having no nutrition or easy access to fluids for what could have been 12 hours. The woman said that if I needed anything for my mother I should come to the desk and ask for it. I said that the reason I had not sought anyone earlier as that I appreciated they were all busy and I was trying to let them get on with their work. I accepted that we as a family should follow this procedure in future. The woman then said she would go and get some dinner for my mother, I asked her to let me know the result of her investigation as to how the system between the ward and the kitchen had broken down. I went back into the room.

The nurse then popped her head through the door and advised me that my mother should not have had ice cream and explained it could turn to water and cause issues around swallowing. I contacted my niece again and she advised that she had asked staff if my mother could have ice cream and was told that she could. On her return with food the nurse advised she had completed a "day text? " I am not sure what this is and presumed it was a report to someone presumably with an outcome, but she gave no further information. Around so 35 minutes later my older sister and younger brother arrived and I explained the situation to them. as I was standing at the ward door I saw a notice which had been altered but showed visiting was from 13: 30-18: 30 hours, underneath was the information around protected mealtimes which welcomed family support.

Around 10 minutes after I had fed my mother some hot food she said she did not wish anything further. I asked if she would like custard and she said that she would, I followed the instructions from the woman in uniform and went out of the ward to the desk, I rang the bell and despite there being 4 nurses further along the ward no one responded, I rang the bell again. no one responded. I put myself in view of the nurse and one of them called along the corridor just to leave them on the table. I had to call back explaining I was looking for custard for my mother. She got up and eventually found the item we had provided in the ward fridge which my mother consumed.

we were also informed that when my mother was moved into a larger room, we could not stay to support feeding as "this would keep the nurses off their work"

So long story, but my overriding worry is that despite the woman in uniform assuring me "this never normally happens" the attitude, lack of ability to apparently see the wider picture, lack of process and failure to communicate will result in older people being left even more vulnerable that they are already. The arbitrary altering of ward signs and welcoming family support apparently can be disregarded at an individuals' whim. This does not fill me with confidence that my mother will be well looked after whilst she is in Ward 4 at the RAH.

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Responses

Response from Lorna Gray, Patient Experience, Public Involvement Project Manager, NHS Greater Glasgow and Clyde

Dear Allank,

You have highlighted a number of issues here which need our attention and we would hope you would be able to help us in addressing this as soon as possible. From what you have said, it seems like your Mother may still be a patient with us, and so it would be really beneficial for her and you as a family if we can get to the bottom of this and create a more positive experience from now on.

I would really appreciate if you could contact me directly on lorna.gray@ggc.scot.nhs.uk with a bit more information, but I would also like to assure you that the General Manager for the service has already been made aware of your concerns and has set the wheels in motion to highlight these to the relevant teams.

Best Wishes,

Lorna

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Update posted by Allank (a relative)

I have contacted Ms Gray and will update PO when I heat from her