"Questions about my father's care"

About: Queen Elizabeth The Queen Mother Hospital / Cardiology William Harvey Hospital / Cardiology

(as a relative),

I first got in touch with the patient experience team at the end of October 2012, when my father was in QEQM in Margate. He had been experiencing severe angina attacks and as a result was admitted a few days earlier.

Due to the severity of his condition while in A&E, as is customary, he had received blood thinners; however he experienced an extreme reaction to that intervention and asked medical staff constantly during his entire stay, why he was experiencing various intense reactions and there was little interest shown and no investigations. I can confirm that he made this known several times within my hearing.

He had increased temperature, pain and other symptoms on the Friday and did receive monitoring on the first ward, however all of this ended when he was woken from his sleep and moved late on Saturday night to Fordwich Ward. He did not understand why he was being moved given how ill he was feeling, and he was not given the chance to properly express this. While being moved to Fordwich, he experienced an angina attack, he told the individual moving him. This was ignored and he was placed in Fordwich anyway.

After his admission and the initial work in the first few hours, during the rest of his stay, he was not monitored with a heart monitor or any other equipment to gather data about his heart rhythms, nor was there any investigation using the ward based mobile echo equipment, despite him advising that he was experiencing increased feelings of congestion in his heart and regular and constant angina attacks. I did not see these being recorded in his notes, despite reminding the nurses to do so.

While on the ward, he was kept awake all night by the shouting of a patient who was becoming violent and throwing objects and other patients with dementia, his three fellow patients in his section of the ward were in a state of undignified undress, exposing themselves to visitors and being unaware of doing so. This became the pattern for the following nights, getting little or no sleep. He felt unsafe and concerned.

I contacted the patient experience team due to my very serious concerns that he was not on a proper regime of medical monitoring, plus he had not been attended by a doctor since the Friday. The only observations being taken were his blood pressure once in the morning and once in the evening. The ward filed an on-line incident report on the Monday regarding the lapse in the protocol regarding the doctors/ consultants not responding to their requests for them to attend him.

As a result, there was no data on his file, which would have provided information and medical detail for his doctors/consultants to make informed clinical decisions on his behalf. His verbal information, which was being repeated and given to everyone who came to his bedside, was also dismissed and ignored.

Despite the complete lack of proper data regarding his condition, and showing no attention to his information, he was discharged from Fordwich on Tuesday morning, by a consultant who did not physically examine him. I believe that this visit was prompted by several phone calls by myself to the medical secretaries that morning. By this time my father was in an extreme state of anxiety and distress, given the lack of any proper attention from nursing staff and doctors. He was worried and concerned at his angina attacks and that no one was listening.

Post discharge, the next day, I telephoned the hospital and spoke to the doctor who discharged him. I reported that he was experiencing angina attacks, even while at rest during the night, every four to six hours and was told that this was not an issue, and to continue taking his spray.

A few days later, in the early hours of the morning, my father was taken by ambulance to QEQM. He was subsequently transferred to William Harvey in Ashford and spent the next two weeks in ITU, the high dependency ward and the Cambridge Ward.

He had suffered a severe heart attack and cardiogenic shock and was put on a balloon pump while in ITU and his life was in danger for several days. In addition, he suffered severe and unusual complications from his reaction to blood thinners. He has permanent heart damage as a result.

I have some questions about the stay at QEQM:

1. Why was the protocol for an unusual reaction to blood thinners not followed, when my father advised of his symptoms hours after his admission?

2. Does his medical file show that he reported it?

3. Are the angina attacks which he experienced during his stay at QEQM recorded fully and completely on his file? I personally, reported three attacks to the senior nursing staff, (which I have recorded electronically) and saw no notes made.

4. Why did he not have a heart monitor, to record the angina attacks and to provide important information?

5. Why did he not have even a basic examination of his heart using the ward equipment? this would have shown any change in the blockages in his arteries.

6. Why was he not given a priority angiogram, nor any prospect of one, given that the last investigation had been two years ago?

7. Why was he moved between wards on the Saturday night and no continuity of care provided?

8. Why were there no proper medical observations made during his time on Fordwich?

9. Why was his consultant name changed when he was moved to Fordwich, to that of a consultant who was on holiday and absent from the hospital, as confirmed to me by his secretary?

10. Why did the doctors ignore the visit requests from Fordwich and fail to follow protocol and fail to respond to the nursing staff?

11. Why, upon his readmission to QEQM A&E, was there no continuity in the hospital records to show his reaction to the blood thinners? This would have been invaluable information for the medical teams at the William Harvey and may have avoided severe, life-threatening complications subsequently.

12. I have asked to see a full paper copy of ALL the medical records held at QEQM for my father, and any of his records held by the EKHT.

It is my contention, that during the first stay his medical record was not being fully and properly maintained. For example, I would expect that the many angina attacks he experienced should be in his notes. If that data is not present, then that will form the basis of some very serious questions about the failure in his care.

It is also my contention that his care did not follow the correct procedures and protocols. I suggest that as a result, his medical and nursing care was sub-standard and potentially negligent.

To be clear, my father and I am expecting a formal written report which addresses these issues - following a full and formal audit and review which conforms to the full Complaint Procedures, including statements following documented formal interviews with all relevant members of staff from the Trust. Plus a statement from the Trust detailing what will be done about the conclusions and findings.

It is now six months since I first contacted Patient Experience. I understand that there is a stated, expected response time within the process to respond to this sort of issue. I would have thought that given the severity of this matter, it would be given full and prompt attention. I am still waiting. So is my father.

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Response from Julie Pearce, Chief Nurse + Director of Quality + Operations, East Kent Hospitals University NHS Foundation Trust

Thank you for posting your concerns via patient opinion and I am sorry that we do not appear to have handled your concerns effectively or in a timely way through the Patient Experience Team. Please do email me and I will follow this through for you. My email address is Julie.pearce1@nhs.net. I will ensure that the questions you have outlined are addressed.

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