Any nurses around this evening please?

[Longhotsummers]

DD is an in patient and is on medication to treat her condition. She had a sudden deterioration yesterday evening which we couldn’t understand as she has been doing so well and today, a doctor told us that her main medication had not been given as it should have been on Thursday and Friday, which was a mistake.
Can someone who works on a ward please explain what checks there should be to ensure a patient has been medicated as per the instructions of the consultant, and as they have been for the past 10 days. The doctor who informed us today was at a loss to understand and said she would investigate but, in the meantime, I’d like to know what standard procedure is please.

@endofthelinefinally taking photos of notes, isn't allowed. You are not allowed to read your own medical notes. You have to apply to the Caldicot guardian. Personally I think it's ridiculous.

They should have a procedure to follow to investigate what happened and they are obligated to fully inform and update you. Make it clear you want an investigation; you want to know how this happened.

This is not permitted. As the above poster said , you are not allowed to read the notes of yourself or a family member. You have to apply to the hospital to be able to do so and then this will be done with a member of staff present to explain what you are reading . This is because there may be sensitive or upsetting information.

I’m actually quite shocked that you did this. You invaded your father’s privacy for one thing even if you didn’t know the technical reasons for not doing so.

And was able to evidence the hospital trying to cover up shoddy work. Sounds like it did the job to me.

I have and would again happily take photos of my notes. As PP has said, notes can go ‘missing’ and everyone is entitled to a copy of their notes under a subject access request. This gives the hospital a month to complete.

Sorry to hear about your DD OP. Hope she is on the road to recovery very soon.

Having experienced notes being hidden, falsified and containing barefaced lies, I don't blame anyone if they take a photo. Especially if the patient is vulnerable. It is an awful position to be in.

The meds were clearly correctly prescribed as they were given for 2 days.

I understand why you would like to understand the process, however, all hospitals do have different processes, and tbh, mumsnet is not the right place to be asking. Look at how many people are simply saying, take a picture of your daughters notes. That's not helpful or going to give you an answer.

The hospital should have their own reporting system (datix) which is used to report anything going wrong. It then gets reviewed by the relevant seniors who should investigate what went wrong. It's not always a quick answer.

You should also contact PALS and the ward manager separately. The manager should be able to explain the process or what went wrong and PALS is who you go to to make an official complaint.

There are so many reasons why her medication may not have been given- not prescribed properly, it may interact badly with any new medication that was deemed more important to her health, may not have been prescribed properly, it may have been prescribed but then cancelled. It could be negligence or human error, or both.

I was present when a consultant ordered a blood transfusion for my mum. When I asked her the next day how it went she said it hadn't happened. I asked the nurses and there was a flurry of activity and she was given it. I'm convinced that it saved her life. I think that you need to make your own notes while it's fresh in your memory and then raise a complaint.

It's really difficult to say without knowing what it was and having the details to look over so it would be best to raise it with the senior charge nurse and PALS and try to get the paperwork looked over.

Most hospitals use an online medication record and when meds are due they are present when you click on the medication record. They don't go away until you action them. So it would be hard/borderline impossible to forget a med over 48 hours because there would be another nurse on in that time who would investigate why it hadn't been given. Unless there was a clinical reason why it hasn't been given (meds unavailable, no access, pt nil by mouth) but again someone trained needs to investigate if that was an appropriate response.

I'm sorry your daughter has deteriorated, I really hope things start to improve for her very soon now she is recieving the treatment.

Won't be allowed access to her notes - will have to put in a FOi request

I’m enjoying all the ‘it wouldn’t happen’ / ‘it’ll be the doctor’s fault’ responses, when clearly it has happened and it was at the point of giving the meds.

Things like this happen all the time unfortunately, they’re also covered up all the time. I imagine that the advent of electronic notes was a huge contributing factor in errors in treatment because patients and their families can no longer be the second pair of eyes, checking that things are done.

Are the drugs meant to be given at a specific time.this caused issues for my child as his regieme did.not fit hospital schedule so I had to keep demanding them.
Eventually ( it was a long stay) I took control and kept his drugs and I gave them as and when required. They did not like it but I could not let him get worse. I always told them when he had taken them.They gave him the extra ones they had percribed for the reason he was in hospital.

This is the point where notes are ‘missing’ we found unfortunately so unless you get the proof at the time it gets covered up

Yes. In our case the notes were "missing " for 5 months. when they turned up, sections had been rewritten and new pages added. Perhaps with electronic records this might be easier to audit. But you still need the auditor to be impartial and not in cahoots.

Exactly. We were able to say ‘we know the name of the dr even if you can’t remember’ and when they said tests had been done that hadn’t and medication given that hadn’t we had all the notes to prove that - if we hadn’t they would have lied, removed sections of notes and we wouldn’t have been able to do anything !!

Notes belong to the hospital and the patient and are supposqed to be kept secure and confidential. If they are left in a room, by the bedside or on the table and a patient or nok photographs them who is seriously in the wrong here. No one will get arrested for photographing their notes. There might be an investigation but if the notes weren't left lying around, doctors were transparent and patients or relatives had confidence that nothing would be falsified then there would be no need to photograph them. At best the consultant, ward manager and PALS would ask why the patient or nok felt the need to photograph them. If its done out of malice, the patient didn't or couldn't consent that would be different but what action would be taken

If you know the name of the nurse you can contact the NMC as it's a significant failing

Thank you all. Although I appreciate different trusts and hospitals have different procedures, you have shown me that there should be systems in place to avoid this happening, which is what I thought had to be the case.
The duty doctor yesterday said it was a mistake and was going to find out why meds hadn’t been given as they should have been two days in a row. She confirmed the meds were available and on the ward but was at a loss to explain whey they had been “missed”.
We have a meeting with the consultant tomorrow so will follow it up then. In the meantime, DD was much improved yesterday evening, which is the main thing.
Thank you all again.

I'd love to hear the explanation for the missed meds once you get it. Just because if meds were not given for 48 hours, that would have involved at least 4 different shifts so a minimum of 2 nurses but more likely 4 different nurses ignoring a prescription. I find that so hard to imagine as a nurse myself. (For a drug that has been in stock and a cooperative patient).

If you have concerns about your child's condition deteriorating please be aware you can cite "Martha's Rule" and get an urgent second opinion on their prognosis and treatment plan

www.bbc.co.uk/news/articles/cndd41p5g82o.amp

Yes. I can only imagine this could happen in situations where the drug chart hasn’t been documented correctly.

Except it was administered correctly for the 2 days prior, so it is very much a mystery

Maybe it was administered but not recorded? (No less dangerous)

Could be. But again by a number of different nurses? That is what is throwing me. Would be interesting to see the prescribing history. As in, was the drug temporarily suspended by accident by a doctor who doesn't want to admit to it? But again, all of that would be traceable in the online system.