A&E excellent/unsafe discharge . . .

My mother died in Broomfield Hospital this year 2015.  This is my review of how my mother was treated by Broomfield Hospital and how she was initially discharged and then readmitted one week later. The discharge letter claimed my mother had made a good recovery. However, the fact that she died 3 weeks later of primary cancer amongst other things is proof enough that she was still seriously ill when discharged. They needed her bed. It’s as simple as that! The family were not consulted about my mother’s discharge, despite the fact that the discharge letter acknowledged that my mother suffered from confusion when admitted, which they said was normal for her.

Almost a year before my mother first entered Broomfield Hospital she had been diagnosed with two forms of dementia. The process of obtaining a diagnosis took 6 months from the time I first went to speak to my mother’s G.P about her symptoms. It was already pretty obvious to me that she was suffering from dementia and I had the distinct feeling her G.P knew it too. I found a letter from her rheumatologist to her G.P a few years earlier in which he acknowledged her fears that she would get dementia like her younger sister. My gut feeling is that my mother’s symptoms had been ignored by her G.P because of the potential cost of dementia medication.

In the few weeks prior to my mother being admitted to A&E at Broomfield Hospital she had not been eating or drinking well and we were becoming increasingly concerned about her health. Tests had just indicated that she had some form of infection and we were waiting upon further test results for clarification.

On the XXXXXXXXXXXX 2015 I received a phone call early one morning from the neighbours living opposite my mother. They had found her collapsed on her back doorstep on concrete early in the morning. Unbeknown to me she’d been left alone the night before. She had fallen badly hitting her head and it was freezing cold outside. She was barely conscious. Nobody knew how long she had been outside, but the paramedics later told me that she was extremely cold when they arrived. The next day my mother had no recollection of the fall. She was taken by ambulance to Broomfield Hospital A&E dept. Her body temperature was too low and her kidney function was already impaired as a result. She had bruising to her head, legs and arms. She also had anaemia (long known by the G.P due to her arthritis medication), blood poisoning and was dehydrated. The doctors at A&E were excellent and I have no doubt they saved my mother’s life that morning.

When my mother’s condition had stabilised at A&E she was eventually admitted to XXXXXXXXXX ward. It soon became apparent that my mother’s lack of appetite/interest in eating continued in hospital. The nurses tried to encourage her to eat, but she declined and it was obvious from the food charts her intake was minimal. Of course the IV drip and increased steroids initially helped a great deal, together with IV antibiotic treatment. After about 5 days my mother was taken off IV fluids. She continued to show little interest in drinking fluids or eating and I noticed a clear deterioration in her condition after IV fluids were removed. I noticed one day that fluids that had been left there for my mother to help herself were kept out of her reach!

There was no communication to me from staff about my mother’s condition, even though my wife and I visited every day. As my mother’s short term memory was extremely poor she was unable to tell us much. I found a checklist with my mother’s notes and it included whether or not there was a lasting Power of attorney. Nobody had asked or bothered to check if my mother had one and this seemed most strange considering she had dementia! I did indeed hold a LPO. On day 6 I heard that mother had seen someone who had been asking her lots of questions. I later found out this was due to the fact they had decided to discharge her without any consultation with family! Apparently she had seen both an occupational therapist and a social worker without informing the family. I have no idea exactly what questions they asked my mother or whether my mother answered the questions correctly and the fact she had dementia didn’t seem to matter to either the OT or social worker. They deemed her to have capacity as they claimed she was lucid. Just because someone is lucid doesn’t mean to say they can answer questions correctly. Previously a social worker (outside of the hospital) had deemed my mother not to have capacity with making decisions regarding her own care. I later discovered the social worker/OT therapist had recommended that my mother spend 6 weeks in XXXXXXXXXXXX for rehabilitation. My mother had refused, not understanding what  XXXXXXXXXX was. I later talked to XXXXXXXXXXXX and they told me that they didn’t take patients with dementia and they often had to refuse referrals from Broomfield hospital for this reason. There had been no communication with family at all!

After some complaining and explaining that I held a Lasting power of attorney for my mother I requested to be present when the social worker talked to my mother again. Basically Broomfield wanted to send my mother home as they needed her bed. I complained to the social worker that my mother was still too ill and not eating enough to keep a fly alive and wasn’t drinking without prompting. The social worker looked on her chart and agreed. Then why were they letting her home? My mother hadn’t even understood what Drakes House was and I suspect this scared her! The OT therapist turned up and a discussion began about re-ablement care. The social worker and the OT therapist strongly disagreed about whether my mother qualified!!! The OT thought they didn’t take anyone with incontinence etc. There was an obvious tension between these two people. I wasn’t happy my mother was being discharged. No doctor had spoken to me or my brothers, only a social worker. My mother was discharged the next day. She was barely eating or drinking and nobody seemed to care about this fact or wonder why! Someone mentioned that it was her free will whether she ate or drank!

I believe that it was painful for my mother to eat/swallow and she was unable to articulate this to family or the medical staff. It seemed nobody cared that this had been going on a few weeks now and if the infection was now under control appetite should have increased. I had to arrange at very short notice for private carers to come in 4 or 5 times a day instead of the usual once and 5 family members including my wife and I cared for my mother. The hospital had changed my mother’s medication without advising family, so when the carers arrived the first time after my mother was sent home the MARS sheets from the carers didn’t tally with the medication from the hospital. The carer was forced to get permission from her boss. I later read the discharge letter from the hospital and they claimed my mother had made a good recovery! Well she had to go straight to bed as she was so ill and exhausted when she arrived home. Her infection may have been under control on discharge according to them, but she was obviously seriously unwell and was bedridden.

The hospital had put her on laxatives due to giving her iron, so we had major problems on our hands trying to cope with double incontinence in addition to trying to keep her hydrated and get small amounts of food into her to keep her alive. I had to call the G.P. out on the Monday as it was obvious my mother was very ill. We couldn’t get her to eat or drink much. It was a nightmare dealing with the double incontinence and she was barely eating or drinking. By Wednesday I phoned the G.P again, but they refused to visit my mother. This despite the fact that a district nurse felt she was dehydrated. Eventually, my mother’s own G.P finally came out on Friday and I requested that my mother be sent to the Rapid Assessment Team at the Braintree Community Hospital to find out what was wrong with her.  This was suggested on the advice from Where Is The Care.  We didn’t want her going back to Broomfield!  By now we had been struggling to care for my mother for a week since her discharge with the help of private carers. Her condition had been deteriorating day by day. She was bedridden.

At Braintree Community Hospital my mother’s condition was rapidly assessed by 2 female doctors. The attitude of one of these doctors was extremely abrupt, almost aggressive, when my mother failed to answer fast enough for her liking. I discretely let them know that my mother suffered from dementia! The doctor later informed me this was not on her records that they accessed! I found this a bit hard to believe, but who knows with the hospital system. It also makes me wonder what the G.P wrote when she was referred to Braintree. X-rays showed that my mother now had fluid around her lungs and abdomen. They also said that my mother’s G.P had claimed that the infection markers were now lower than when she was first discharged, but in fact they said the G.P had been wrong because they were actually higher! Braintree informed us that my mother was too ill to be kept there and she would have to go back to Broomfield. Phone calls were made and Broomfield said they would accept her. We were told to be prepared that my mother would probably never be able to return home. That was already obvious. As my mother had been exhausted by the high speed ambulance journey from Witham to Braintree we requested that they take it easy on the way to Broomfield. So now we arrived back at A&E where this had all began.

It was chaos at Broomfield as there were no beds available. In the holding area of A&E I let the staff know that my mother had sores on her heels etc. They then put her on a special mattress. We waited 7 hours to be transferred to a makeshift ward at 1am. She hadn’t been properly medically assessed in those 7 hours. In the temporary ward my mother was not given a special mattress for her sores! The nurses struggled again to get my mother to eat or drink. Still no tests were being done to find out why. In the bed next to my mother was another patient with dementia. A young female doctor was visiting this patient and talking to her daughter and grandson. She had also not been eating and we overheard the whole discussion that this lady was going to die for this reason. The family was told she had to be discharged to a nursing home to die. The family were naturally devastated and deeply upset at the news and we naturally began to wonder if this fate awaited us too with my mother! It was disturbing to say the least to hear what should have been a private conversation. Eventually after a week or more my mother was transferred back to XXXXXXXXXX Ward who had been responsible for unsafely discharging my mother in the first place! My eldest brother informed them that my mother was bedridden and extremely ill. However, when my wife and I arrived to visit my mother we were told by another patient that my mother had been taken out of bed and sat in a chair for over an hour. We were told that she had been slumped over in the chair. It seems that the news that my mother had been bedridden for weeks hadn’t got through to this nurse.

Where was the communication between the temporary ward and XXXXXXXXXX Ward? Why had they not been informed how ill my mother was? This should never have happened. My mother was far too ill to be sat in a chair. My mother continued to deteriorate and it became necessary for us to ask for more pain relief. No special air mattress was provided despite the fact they knew my mother had sores. We continued to ask for one and eventually we were told that one had been ordered and it had my mother’s name on it. However, it never came! My wife and I had already started to wonder if my mother had cancer. She had been through Ovarian cancer over 10 years earlier. She was finally tested for cancer markers and I was informed that one of the markers that should be 30 was in fact 600!!! We had to make the decision to not investigate this cancer further as my mother was so gravely ill. She didn’t have very long to live. I told the doctors that it was a disgrace that my mother had been discharged from XXXXXXXXX Ward in the first place. This was greeted with silence. Our family had been subjected to an immense struggle looking after our terminally ill mother for a week when she was also suffering double incontinence. It had been a heartbreaking and immensely stressful struggle to care for her and getting any fluids or food into her had been almost impossible. It was just inevitable that my mother would have to be readmitted to Broomfield.

The care agency we had employed to help my mother did a good job in general. Most of the girls were brilliant, the odd one or two were not up to scratch. They were a great support to us in the week after mum was unsafely discharged. We could not have managed without them!

My mother was by now extremely weak having lost considerable weight. Even the noise from other patients and people visiting the ward was too much. She had terrible pain and was on morphine. Now a junior sister abruptly told me that my mother had to leave the hospital because she couldn’t die there. She told me she wouldn’t want her mother to die in hospital and this made me feel even worse! My wife and I were forced to try and find somewhere that could offer end of life care. We did find somewhere, but they informed me that they needed certain paperwork from the hospital. The junior sister said that such paperwork wasn’t necessary and said they were being ridiculous. This junior sister showed no compassion at all. A senior staff sister offered to let me speak to the nursing home from her office. It now seemed that they required over £5,000 up front before they would take my mother. Stress levels were horrendous and my mother was deteriorating fast. I told the Sister that I didn’t think my mother would survive the ambulance journey. She said they didn’t want that to happen either and agreed it was now too risky to move her. I had been asking for a private room, but none were available. Another patient then died and my mother was allowed to have the private room. Now at least we had some privacy to prepare to say goodbye to our dear beloved mother of 82. When the nurses all found out that my mother had cancer they were much more compassionate and did everything they could to keep her comfortable. We were allowed to stay overnight in the private room and stayed with my mother 5 or 6 days and nights until she passed away with my wife and me at her bedside.

At no point was my mother ever given an air mattress despite the fact that it was clearly made known to the hospital on her arrival and the promise of one. Communication between wards was non-existent, medication changed on release without prior notification to family and ultimately they had originally discharged my mother who was terminally ill with primary cancer without any effort to discover why my mother was barely touching food or water. They said she had been successfully treated for sepsis and had made a good recovery. They didn’t mention she wasn’t eating or drinking. It was also noted that my mother should in the future no longer be co-prescribed methotryxate at the same time as a specific antibiotic for UTI’s as this could cause bone marrow failure!!!

Hospital policy and the pressure on doctors to free beds in a hospital that was full to the rafters was ultimately responsible for great suffering and anxiety for our whole family at a time when my mother was dying. Why were we the only ones that could see how ill she was? My mother was terminally ill, yet in their medical opinion she had made a good recovery from sepsis! Only when my mother was re-admitted did it dawn on Broomfield Hospital to look into how ill she really was and yet it still took them a long time. My mother’s unsafe discharge showed grave incompetence and negligence and caused immeasurable distress to my terminally ill mother and all my immediate family. My mother had worked her entire life and retired at 65. She deserved better than to be treated like an irrelevant number and dismissed home without due care. It feels to me like they operate with a mentality that patients are an inconvenience and they must do whatever they can to quickly patch them up and get rid of them. This leaves vulnerable sick elderly people at their mercy. There are some wonderful doctors and nurses working in the NHS, but they are working in a sick system that needs to change to show more respect to the elderly, communicate fully with family and don’t discharge patients without acting with due care.

 

Things That Need Improving:

  1. Don’t discharge patients before they are well enough to be discharged. This is hardly rocket science and ultimately will save costs and lives. (With the elderly or vulnerable there must be better consultation with family) My mother couldn’t make sound decisions regarding her own care.
  2. Better communication between staff and wards and better training for nurses not to act on assumptions about patients.
  3. Better communication with family.

Name

Anonymous

Town

Tiptree

Date Experience Happened

2015

Category

Hospital