"Excellent care let down badly by the..."

About: Southampton General Hospital

What I liked

My husband was admitted for elective Thoracic surgery, thoracotomy and left lower lobe lobectomy for lung cancer. Professional caring staff, high level of skill and care, time taken to explain procedures pre-op to husband (the patient)and myself. Great care taken over my husband's blood clotting/bleeding problems pre and post-op Sensitive nursing post-op re diet and emotional distress.

What could be improved

Pain control over a weekend period left a lot to be desired. My husband was admitted for surgery on a Friday. We had been told that surgery would be very painful but copeable with ,with the correct pain control measures. We were told that if problems were encountered the Specialist Pain Control Team would be called in,. The Specialist Thoracic

nurse emphasised that mobility, deep breathing and coughing were essential for good recovery and that pain control was of great importance for this. . The aneasthetic registrar explained to my husband that pain control could be diffciutlt to achieve post surgery. The Consultant Amnaethetiist explained to my husband immediately pre-op that it would be too risky for my him to have spinal nerve blocks for post-op pain control as the risk of bleeding was too high; my husband was to be given IV Heparin 6hrs post -op and Warfarin 24hours post -op. My husband was comfortable when I visited him the evening after surgery, with IV paracetamol, PCA morphine and a local anesthetic infusion into the wound. When I visited him at 3.00 the next day, Saturday , he was experiencing excruciating unbearable pain. I brought this to the attention of nursing staff who quickly changed his pain control regime to paracetamol, dihydrocedeine 60mg and oramorph 2- 4 hourly. When I left the ward that eveing my husband was not comfortable but was coping with the pain. On Sunday , he was again experiencing extreme pain. He had had a drain removed, and had had to move out of bed more. He was in great distress. Again I alerted the nurses who again reviewed his medication and suggested he could have the Oramorph 2 hourly- why had this been changed to 4 hourly.? I asked about calling in the pain control team and was told it was only available Mon to Fri. Why was my husband scheduled for such surgery on a Friday if there was to be no pain control support for him over the weekend?He needed more skilled help than the nurses were able to provide.

Anything else?

I wonder if the 1 to 3 pain scale used by the nurses on this Thoracic High care Ward was less than helpful. If the scale had been 1 - 7 , my husband would have said 6 giving a clear idea of his distress, on 1-3 he would say 2 as to him,for 3 he would have been calling out in agony - in fact he was gripping the arms of the chair and gritting his teeth in order not to call out. I also wonder if the nurses involved in his care appreciated that he had not had spinal nerve blocks as some of their comments indicated that they wondered why he was in so much pain.What criteria need to be met in order to ask for extra help to be requested post-op for a patient such as my husband?

It was hard for me as a relative to see the Specialist Pain Control Team nurses going round the ward to visit patients during the following week, knowing that such help had been denied to my husband. Possibly there would have been little extra to have been done for him due to the inherent bleeding/clotting problems but at least my husband would have known that all possible avenues had been explored to help him.Regional anaetheticNervousPatient careWardConsultantsNursing staffLung cancerLung or respiratory tract surgerySurgeryStaffing LevelAnticoagulant drugsParacetamolWoundsAttentiveMedication review

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Response from Southampton General Hospital

Sylvia – many thanks for your detailed comments. We are extremely sorry to hear that your husband experienced unnecessary pain after his thoracic operation, particularly as we have set high standards for patient care, which includes effective pain management. As a result, we have reviewed the post operative pain management arrangements in the thoracic ward and cardiac high care unit. This includes encouraging patients to inform nursing staff of uncontrolled pain so that appropriate action can be taken in a timely manner, which should alleviate unnecessary suffering for the patient. Our critical care and theatres service (which includes anaesthetics) will also be reviewing and identifying possible improvements from your feedback, which includes the availability of the specialist pain team. If you would like a more personal, direct response, please do contact our Patient Advice and Liaison Service on pals@suht.swest.nhs.uk or 023 8079 8498, as unfortunately we cannot obtain contact details for you from the NHS Choices website.

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