Almost a catastrophic mistake

[Surfer01]

OH was phoned last Tuesday by a rheumatology specialist who said OH needed to come into hospital for a scan and they had a bed and medical staff waiting for OH and it would take a few hours.  On arrival at hospital and going to the relevant department, no one knew anything about it.  The specialist was not available and could not be found initially.  Eventually they tracked him down and OH was told to go to A&E where OH booked in and then waited in A&E for a couple of hours as no one knew what was going on and by this time the specialist had gone home anyway.  Eventually on early Wednesday morning OH was booked into a bed in A&E.  OH had not eaten or drank anything since breakfast on Tuesday morning and in A&E no drink available plus OH never had any money as did not expect to be staying at hospital for long.   

 

A blood test was done on Wednesday morning and red cell count was low so they gave OH a blood transfusion and was told that OH would be discharged later the same day.  The rheumatology specialist disagreed and OH ended up staying another night, but was transferred to a hospital ward late Wednesday night.  No sign of the medical team etc.  On Thursday staff told OH that OH would be discharged later the same day, but again a disagreement between departments meant OH stayed another night.  On Friday told that an appointment has been made for the Monday and if OH is discharged on the Friday and goes home OH will lose the appointment so OH spent the weekend in hospital.  In all this time OH had only seen the specialist who had phoned and told OH to come into hospital once and that interview was for about 10 minutes.

 

However where they had inserted a cannula for the blood transfusion, OH's wrist started swelling and there was pus coming out of it so they removed the cannula on the Saturday which had been in since the Wednesday when they did the transfusion.  OH had a thin red line from the infected area right up to her elbow joint.  They said sorry and wiped it clean, but pus continued to come out of it over the weekend.  OH was not given any antibiotics.

 

On Monday a different specialist from the gastro department came and told OH that they would be conducting an endoscopy at midday.  When the time came for the endoscopy, OH was told that it had been cancelled as there was no need for it and OH could go home.  No reason given for the cancellation.  The discharge option was countermanded by another doctor or specialist and OH ended up staying another night. 

 

On Tuesday morning OH told again that OH would be discharged later that day after doctor visit.  Eventually at about 1pm a doctor came around and confirmed that OH would be discharged as no reason for OH to stay in hospital.  Doctor said it would take a couple of hours for discharge papers to be processed through the system.  Eventually discharge papers came through at about 6.30pm.  No reason why it should take so long in this day and age.

 

OH was then prescribed an antibiotic medication and told to go to the hospital pharmacy to collect it.  As it was already late and dark, we decided that we would travel back to the hospital the next day to collect  the medication.  On arrival at home and looking at the medication, it was for an antibiotic that contained penicillin and OH is allergic to penicillin and it may have killed OH as OH's immunity system is compromised.  OH's medical records indicate that OH is allergic to penicillin plus while in the hospital issued with an arm band which clearly indicates that no penicillin should be administered.  This is a really big mistake for a doctor to make.  Just after 8am this morning OH had a phone call from the sister on the ward who had noticed that the doctor had prescribed an antibiotic with penicillin and OH was advised to contact her GP for a suitable antibiotic. 

 

Basically OH should never have gone into hospital and should never have been made to stay in hospital for a week.  OH should not have had an infection develop where the cannula was inserted and should never have been prescribed a drug that would have killed OH.  We are very concerned about this and feel we need to approach an organisation called PALS who are supposed to look after the interests of the patients and resolve issues.

 

OH does not have any issues with the nurses or sisters who looked after her, but is very upset about how the whole episode evolved at management level especially as it was unnecessary in the first place!  Has any one experience of dealing with PALs and is it the correct route to follow to escalate a complaint to the hospital trust? 

 

 

[Ethel Street]

I've no personal experience but AIUI PALS are a support and information service, often volunteers I believe, and won't themselves deal with your complaint or advocate for you.  What they can do though is explain to you how you make a formal complaint about your OH's medical treatment and how to access the complaints procedure.

 

What is PALS (Patient Advice and Liaison Service)? - NHS

WWW.NHS.UK

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Find out more about the Patient Advice and Liaison Service (PALS), which offers confidential advice, support and information on health-related matters.

 

 

You need to make a formal complaint to the NHS hospital trust. 

[BazzaS]

“ As it was already late and dark, we decided that we would travel back to the hospital the next day to collect  the medication.”

 

Not a good idea if antibiotics are needed : delay can be dangerous, especially if there was concern of infection that could go into the bloodstream such as from a cannula site

 

“On arrival at home and looking at the medication, it was for an antibiotic that contained penicillin and OH is allergic to penicillin and it may have killed OH as OH's immunity system is compromised.”

 

Some misunderstanding there, I fear.

The key is what the penicillin allergy is (some allergies can be severe / life threatening, but many aren’t), so what matters is what happened with the penicillin allergy, when, and also what classes of antibiotic they’ve safely had since.

 

People whose immune systems are compromised are more at risk of severe infection because the immune system (which is complex and multi-faceted!) doesn’t work as well as it should.

Since allergy is when the immune system “works too well” and ‘over reacts’, a compromised immune system doesn’t usually cause more severe allergy, just “as bad as usual”.

 

You could complain to the Trust, but equally you could complain to the Commisioners who pay for (Commision) the service from the trust (since it is them paying for it). This will be what used to be “the health authority” (which then became the PCT (primary care trust), which then became the CCG (Clinical Commisioning Group), and their latest incarnation is the ICB (integrated Care Board).

 

They have an added interest over and above the penicillin allergy issue as they are paying for the “bed days” that have been lost if the admission wasn’t needed or was prolonged without reason!

 

https://www.nhs.uk/nhs-services/find-your-local-integrated-care-board/

 

Edited February 8, 2023 by BazzaS

[dx100uk]

neighbour is a 4 times cancer patient, now on immuno, with dual kidney stents.

cannular is very regularly used.

if they have a flare up, penny is always used even though they are 'allergic' too it.

 

[BazzaS]

USA data, but about 10% of the population states they are allergic to penicillin, but only 1 in 10 of that 1 in 10 (so 1 in 100 or 1%) actually are.

 

https://newsnetwork.mayoclinic.org/discussion/why-should-i-be-evaluated-for-a-penicillin-allergy/

Testing for penicillin allergy is available in the U.K. but is much less commonly done, though the “1 in ten, of 1 in ten” is similar

https://www.bmj.com/content/358/bmj.j3402

 

[Surfer01]

OH has been tested and is definitely allergic to penicillin as a few years ago nearly died because of the allergy and had to be resuscitated. If the medication had be collected that same evening when I collected OH, there is a strong possibility that OH would not be with us at present.

[BazzaS]

Though you both realised when you got home …. So might have realised the previous night, too.

 

Sounds like a definite (& severe) penicillin allergy, unlike dx’s neighbour.

 

Having previously asked an expert about a similar situation, I suspect they shouldn’t (wouldn’t?) even risk  “relatives of the penicillins” for such a severe allergy, with one exception…… if someone had inadvertently prescribed one of those “relative” antibiotics AND “got away with it by luck” AND this was since OH’s allergy : they’d know they were safe for your OH.

I’d had this explained to me as “this is because about 10% of people with penicillin allergy will also be allergic to antibiotics in those groups related to penicillin : I’d not take the 10% chance of killing someone if we don’t know, but if someone else already risked it, and as a result we know they are in the 90% who are safe, we can rely on that info!”

 

Apparently this is important for some severe infections where the penicillins / “relatives of the penicillins” are the most effective choices, so they don’t have to use the less effective alternatives. Hence (above) “what matters is what happened with the penicillin allergy, when, and also what classes of antibiotic they’ve safely had since.”

 

Mind you, if OH was tested for penicillin allergy : did they comment on / test for “allergy to those relatives of penicillins” too (I can go look up the name of those classes of antibiotics related to penicillins if you need)

Edited February 9, 2023 by BazzaS

[Surfer01]

Very true however when you have been waiting 5 or more hours to be discharged after spending an unnecessary week in hospital, you are tired and all you want to do is get it over with and probably would not have picked up that the prescription was not right for you.  You trust the doctor who has given you the prescription that it is correct.

 

Just to add, OH was admitted to hospital on 4 different occasions over the last year each time on an urgent basis.  On the last occasion in October 2022 OH almost died as it took the ambulance 5 hours to arrive. Luckily the district nurse was with OH at the time. 

 

Each time OH was admitted, the professionals seemed to be guessing at what was wrong and even did an unnecessary op to remove the gall bladder and this did not resolve the issue.  It was only on the fourth occasion in October that rheumatoid vasculitis was finally diagnosed as the culprit as they picked that there was a blood clot in the right leg!  Not good. 

 

Now on blood thinners and loads of other medication and on recent stay in hospital, one doctor stating that OH needs to stop taking blood thinners and take less steroids and another doctor stating that OH needs to carry on with blood thinners and increase steroids.  You can't win!

[BazzaS]

“Dr X said the opposite, though, Dr Y. Perhaps you’d like to discuss it between you and come to a consensus, then you both can advise me on the risks / benefits of both approaches?”

 

Posing it as a question, and as a risk/benefit equation can make it less confrontational and avoid risk of bruising  their ego!

Edited February 9, 2023 by BazzaS

[honeybee13]

Good suggestions, Bazza.

 

HB